Discharge Planning
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Case Management’s Role in Managing Denials and Appeals in the New Healthcare Environment
Revenue is defined as the sum earned by the provider, measured in dollars. The revenue cycle is defined as the series of activities connecting the services rendered by a healthcare provider with the methods by which the provider receives compensation for those services. Case management plays an integral role in managing revenue and the revenue cycle in the denials and appeals processes. This month, we will discuss the case manager’s role in the revenue cycle as it relates to the management of denials and appeals.
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Patient Activation Is a Health Promotion Method That Works
Case managers continually learn new methods to educate and engage patients. The key is to find the right method for case managers to achieve their patient education goals. The patient activation measure is based on the theory that there is a great deal of variation in patient activation/engagement in a patient population. Some patients need more support, and should be evaluated to see what works.
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The Inner Workings of a Health Coaching Program
Hospital case managers and others interested in extending case management through the use of student health coaches can implement a health coaching program with a local college. Both hospitals and colleges can benefit from the collaboration.
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Hospitals and Colleges Collaborate in Health Coach Training Programs
Some small-town hospitals and colleges have found a way to provide pre-med, nursing, and allied health undergraduate students with hands-on medical experience that benefits the community. The student health coaches perform case management-type services for at-risk patients. Called health coaches, these students learn skills years ahead of their peers. They receive college course credit and volunteer or internship experience. And, they contribute to positive health outcomes, including keeping patients out of hospitals and EDs.
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Reducing Long-Term Patient Costs Requires Going Above and Beyond
Case managers in hospitals and community settings often have to go beyond point of care activities to help patients make significant improvements in their health and healthcare costs. This is particularly true with patient populations experiencing major barriers to maintaining disease control and health improvement, including housing, food access, transportation.
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Brain Trauma: What Case Managers Should Know
When brain trauma patients are discharged from hospital intensive care, a rehabilitation facility is the next step. At the rehab facility, a case manager will work closely with a team that helps patients regain functional ability. But often, the family wants to take a patient home too soon in the rehab process. In talking with patients’ families, the importance of “staying the course” with rehabilitation is imperative.
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Transitional Pain Service Helps Patients Reduce Dependence on Opioids
Amidst the national opioid addiction crisis, a Utah nurse with a background in case management has collaborated with a team of doctors and nurses at a Veterans Administration hospital to reduce opioid use and dependence in patients — and their program has gained attention from The Joint Commission.
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A Case Manager’s Guide to Malpractice Prevention
Meticulous documentation, education on compliance issues, and clear communication can help mitigate a case manager's risk of facing malpractice.
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Health Coaching Helps Patients With Diabetes Improve Healthy Behaviors
A pilot study of hospitalized patients with type 2 diabetes found that 80% of patients who received a case management health coaching intervention were not readmitted to the hospital within 30 days of discharge. The patients with diabetes who were enrolled but never participated in the intervention returned to the hospital within the first two weeks post-discharge.
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Better Communication Can Improve Home Health Education for Patients
The authors of a new study suggest that hospitals are not providing patients with enough education about home health services, leading to unrealistic expectations after they are discharged home.