Centers for Medicare and Medicaid Services (CMS)
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Ethical Concerns With Quality Ratings of Nursing Homes
Quality ratings of nursing homes are not necessarily what they seem, according to a recent analysis.
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Johns Hopkins’ Intrahospital Patient Transfer Program Reduces Risk
Adult and pediatric patients moving from one area of Johns Hopkins Hospital in Baltimore to another face less risk than might be found in other institutions because of a program ensuring that they will receive the same quality of care during transfer as they do on a unit.
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Innovative Staffing Model Reduces Handoffs, Boosts Provider Satisfaction
Recognizing the risks to patient safety, many investigators have focused on improving handoff processes to reduce the potential for errors when the care of patients is transferred to new providers.
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Keep an Eye Out for Noncompliance Red Flags
Case management directors can train staff to log their hours, maintain accurate documentation, and follow all payer rules and requirements to maintain compliance with laws and regulations.
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Basic Compliance Training Should Focus on Payer Service Standards
Case management departments can prevent False Claims Act violations by training case managers to follow the rules set by their program funders and payers, including the Centers for Medicare & Medicaid Services.
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Case Study Illustrates How Care Team Works
A healthcare organization’s care team model provides complex patients with holistic care, helping them stay out of the hospital and ED.
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Care Managers Who Are Social Workers Make Magic Happen for Complex Patients
A prevention-focused care management program successfully reduced hospital admissions and ED visits among a vulnerable population.
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Mental Health Crises and Suicide Rates on the Rise
The United States is experiencing a suicide and mental health crisis that national data show is worsening.
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Case Managers Should Beware of Medicare Fraud, Waste, and Abuse Issues
All hospital employees, including case managers, should receive frequent compliance training that includes information about how to prevent compliance problems.
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Separating Utilization Review, Case Management Creates Transitional Care Coordinator Role
Hospitals that still assign case managers to utilization review and care coordination at discharge might consider separating the duties to improve care quality.