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If youre not involved when your hospital contracts with managed care companies, you may miss an opportunity to eliminate denied or avoidable days and maximize reimbursement.
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If your hospital is routinely filing claims under Condition Code 44, which changes a patients status from inpatient to outpatient, your system for determining appropriate admissions may be failing.
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By working as a team, the physician advisor and case management staff at Mercy Medical Center in Canton, OH, have decreased Medicare length of stay, cut managed care denials dramatically, and made physicians aware of the cost to the hospital of inpatient services that could be done on the outpatient side.
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If you arent taking advantage of the assistance your case management physician advisor can offer, or if you dont have an advisor, you may be missing opportunities to move patients safely and efficiently through the continuum of care.
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Drawing on 20 years of quality improvement experience, MPRO, Michigan's Health Care Quality Improvement Organization, is bringing together hospitals, home health agencies, and physician practices to come up with solutions to communications barriers between providers, with the ultimate goal of improving the outcomes for the state's cardiovascular disease patients.
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When Jackson Health System in Miami started its first hospital-based disease management program in 1995, the case management department was able to show that the hospital saved $5 for every dollar the hospital spent on case managers in the disease management program.
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As increasing numbers of older Americans spend their last days in a nursing home, its important for nursing home staff, as well as hospice providers, to identify nursing home patients who might qualify for a hospice placement, an end-of-life care expert says.
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An estranged husband comes into the house while the home health nurse is teaching the patients mother how to do enteral therapy as he begins physically abusing the mother, he looks at the nurse and says, Youre next.
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An initiative that assigns ownership of HEDIS®* measures to various staff members has resulted in improved HEDIS scores and national acclaim for Keystone Health Plan Central, a wholly owned subsidiary of Capital BlueCross, independent licensees of the Blue Cross Blue Shield Association.
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Prices in the commercial insurance industry, which declined steadily in 2004 in the first yearlong soft market since 1998, may be showing signs of a rebound, according to a new survey.