Centers for Medicare and Medicaid Services (CMS)
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Do Not Forgo HIPAA Requirements in Pandemic Response
The Department of Health and Human Services Office for Civil Rights will disregard some HIPAA violations during the pandemic response. Risk managers should understand which parts of the privacy rule are affected.
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EMTALA 1135 Waivers Allow Flexibility
The Centers for Medicare & Medicaid Services issued waivers for some Emergency Medical Treatment & Labor Act (EMTALA) requirements, acknowledging certain expectations are not reasonable to achieve during a pandemic. However, EMTALA still applies.
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Telehealth Rules Eased, but Oversight Still Needed
The federal government acted quickly to make telehealth services more accessible in the COVID-19 pandemic, but risk managers must fully understand the changes to avoid creating liability risks. Some telehealth changes are aimed at making the service reimbursable, and therefore available to more patients. But there also are compliance issues.
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CMS Issues Stark Waivers, Makes Other Allowances for Pandemic
The Centers for Medicare & Medicaid Services issued waivers and allowances that will affect risk management programs, including 18 blanket waivers of sanctions under the Stark Law.
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Telehealth Intervention Provides Solutions for Era of Social Distancing
A recent study revealed how healthcare organizations can design a telehealth pilot program for elderly and at-risk populations with long-term health conditions. Researchers found that using the Model for Developing Complex Interventions in Nursing, healthcare providers could design a multifaceted telehealth intervention to minimize reinstitutionalization of people with multiple chronic conditions.
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COVID-19 Devastates At-Risk Populations
The COVID-19 pandemic appears to have a devastating effect on people with chronic diseases or who are immunosuppressed, are older, or obese. In other words, the people most at risk of serious illness from the disease are the same people case managers help each day. Case managers should focus more on remote case management, taking the pandemic into account as they contact and monitor patients.
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HHS, CMS Easing Some Abuse Rules, Will Reduce Compliance Burden
The Department of Health and Human Services and the Centers for Medicare & Medicaid Services are trying to reduce regulatory burdens on healthcare organizations with rule changes that would protect some activities from anti-kickback allegations. The changes are intended to promote value-based care.
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Study Highlights Effects of Case Management on Reducing Readmissions
A recent study revealed that case management programs helped improve hospital quality and led to reductions in hospital readmission rates. Hospitals that collaborated with home health agencies, used telehealth, or made house calls experienced lower readmission rates related to pneumonia. Case management services and referrals to home health agencies were among the main factors that affected readmission rates.
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Program Targeting Skilled Nursing Facilities Reduces Readmission Rates by 25%
A study from Mount Sinai Health System in New York City revealed that 25% of patients who were transitioned to a skilled nursing facility (SNF) returned to the hospital within 30 days. The organization employed case management solutions to achieve a 20% reduction in the 30-day readmissions from SNFs.
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The Case Manager’s Toolbox: The Essential Skills of an Effective Case Manager, Part 1
RN case managers and social workers are key advocates in the delivery of quality healthcare. Their broad skills and training allow them to assess patients’ needs and work well with families and other members of the healthcare team. Negotiating, collaborating, communicating, team-building, precepting, educating, and consulting are the basis of what a successful case manager brings to the care setting each day. This month will begin a discussion of the skill sets every case manager and social worker should possess to be as effective in the role as possible.