Discharge Planning
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Know What to Look for Before Hiring New Staff
One of the biggest challenges case management directors face is balancing the need to fill the vacancy quickly with the importance of hiring the right person. Before starting the hiring process, case management leadership should look at the current staff’s characteristics and list the skills the ideal candidate should possess.
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It Takes Data to Convince the C-suite to Add Staff
In many hospitals, senior management does not understand the importance of the case management role until the hospital is audited and penalties are assessed. To justify adding staff, case management leaders must speak a language that the C-suite understands, and that is finance.
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Case Managers Are Aging, But Who Will Take Their Place?
Hospital case managers are being asked to take on a bigger, more important role — but, in many cases, staff is not increasing, leading to high caseloads, low morale, and burnout.
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Medical Home Within ED Serves Needs of Sparsely Populated Region
There is ample evidence suggesting new solutions are needed in the way healthcare is delivered in rural America. Multiple factors likely play a role, including the fact that there is a significant shortage of both emergency and primary care providers in rural areas.
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Federal Report Calls for Action to Improve Healthcare Access for Mentally Ill
The Interdepartmental Serious Mental Illness Coordinating Committee released a report to Congress on Dec. 13, 2017, titled, “The Way Forward: Federal Action for a System That Works for All People Living with SMI and SED and Their Families and Caregivers.”
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Patients Threatened by Gaps in Care When They Change Settings
Patient safety and quality of care are threatened when patients move from one setting to another, but there are strategies that can address those gaps in care.
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Revenue Cycle Team Optimizes Reimbursement
If a hospital doesn’t have a revenue cycle management committee, case managers can approach leadership and suggest that they propose that the hospital administration create a committee to review all contracts and denials.
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Large Caseloads Make Denial Prevention Difficult
Hospitals that pile task after task on case managers and assign them large caseloads are unlikely to effectively manage denials.
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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.