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By redefining the roles of case managers and social workers and working with physicians on patient throughput and length of stay, Fauquier Hospital in Warrenton, VA, significantly reduced its Medicare length of stay by almost a day and decreased the revenue lost because of denials by medical necessity by 70%.
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By taking a proactive approach to patient status and instituting a series of checks and balances, Good Samaritan Hospital in Dayton, OH, keeps denials at a minimum.
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When CIGNA members being treated by Piedmont Physicians Group in Atlanta are high-risk or noncompliant, Jennifer Farlow, RN, BSN, clinical care coordinator, contacts them and helps them get back on track for regular visits and recommended tests and procedures.
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Who knew what when? At times, you can be put in a tough position because of what a worker tells you. "We are not safety and we can't discipline, so employees tend to tell us more than they would tell others," says Susan L. Zarzycki, RN,COHN,CM, an occupational health manager at Finch Paper LLC in Glens Falls, NY. Here are some common scenarios and how to deal with each:
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As health care organizations tighten their belts to deal with today's health care environment, case managers report working harder with fewer raises and benefits. But, there is hope on the horizon as new opportunities open up for case managers under health care reform, experts say.
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As talk of reimbursement reform and pay for performance escalates and health care stakeholders look at ways to improve patient access and outcomes while reducing waste and costs, payers and providers are joining together to create accountable care organizations (ACOs), partnerships that agree to be accountable for the quality, costs, and overall care of a patient population.
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Use of alcohol-based hand cleansers significantly reduced several common infections and reduced absenteeism in a study of 129 white-collar workers in 2005 to 2006, according to research from the Institute of Hygiene and Environmental Medicine in Greifswald, Germany.
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As health care organizations tighten their belts to deal with today's health care environment, case managers report working harder with fewer raises and benefits.
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Patient education managers faithfully assess written materials to make sure they are appropriate for people with low health literacy or poor reading skills.
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You probably get the feeling, more often than you'd like, that there is more to the story than what a worker is telling you about an injury. There are several possible reasons for the facts not adding up.
