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Faced with high readmission rates and patients who made multiple visits to the emergency department and were hospitalized frequently, a multidisciplinary team at Lehigh Valley Health Network began analyzing the cases of frequent utilizers one at a time, getting to the root cause of the readmissions, and developing a plan to keep them out of the hospital and emergency department.
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At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.
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Theres no one size fits all for case management training, which means that hospitals need to create their own training and orientation process based on the specific responsibilities of the department, says Beverly Cunningham, RN, MS, vice president of resource management at Medical City Dallas Hospital. What is covered will vary from hospital to hospital, depending on the role of case management, she adds.
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In the Inpatient Prospective Payment System proposed rule for fiscal 2014, the Centers for Medicare & Medicaid Services (CMS) clarified its long-standing policy on how Medicare contractors review inpatient admissions for payment purposes and continued its emphasis on basing reimbursement on quality.
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The continuing shift toward basing hospital reimbursement on quality emphasized by the Centers for Medicare & Medicaid Services in the Inpatient Prospective Payment System (IPPS) proposed rule for 2014 raises the stakes for hospitals, especially those that treat a lot of Medicare patients.
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At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.
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Patient access leaders should explain to employees why collection is important to the hospital and instruct staff on how to correct mistakes.
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To excel at upfront collections, patient access need real-time insurance verification, patient risk scoring, and payment estimation tools, according to revenue cycle experts.
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