Centers for Medicare and Medicaid Services (CMS)
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Be Knowledgeable About Hospital’s Payer Contracts
To prevent denials, case managers must know the requirements of each individual payer. But at some hospitals, the finance and/or managed care departments don’t provide case management with the utilization review section of the contract where the rules are outlined.
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How to Avoid Four Types of Denials
Case managers must take a proactive approach to reducing the denial rate — and the best way to do it is to prevent the denial.
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Types of Case Manager Reviews
This chart shows the types of payer reviews case managers typically perform.
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When Managing Denials, the Best Defense Is a Good Offense
Denials represent a significant amount of lost revenue. Case managers should take an active role in preventing and managing denials.
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How Can an ASC Ensure Infection Control Compliance?
An infection control and prevention quality improvement project should be based on a set of standards. These standards start with federal, state, and local regulations, as well as industry standards.
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ASCs Can Use the CMS Infection Control Checklist to Their Advantage
The ASC Infection Control Surveyor Worksheet could serve as a good tool for ASC administrators to use when assessing their own infection control and prevention policies and procedures.
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ASCs Must Work Harder to Prevent Aerosol Infectants
Infection control and prevention measures, along with using the most effective filters, can help prevent aerosol infectants, including prions.
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Antibiotic Stewardship Requires Hospitalwide Commitment
Hospitals can play an important role in addressing one of the most urgent public health problems today: the misuse and overuse of antimicrobials. An effective antibiotic stewardship program requires significant commitment from top executive levels down to the bedside.
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Community Finds Unique Ways to Bring Case Management to the Frontier
A care coordination program that uses care facilitators has helped to improve care coordination and reduce ED use among a frontier, or very rural, population.
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Strategies for Preventing Workplace Sexual Harassment
Healthcare organization leaders can do a great deal to prevent sexual harassment — or, at least, to stop it as soon as it occurs. Sexual harassment prevention starts with an organization’s leadership paying attention and emphasizing the importance of workplace safety.