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The Centers for Medicare and Medicaid Services (CMS) instructed state Medicaid agencies to develop a RAC program by Jan. 1 of this year but the program is not expected to be in full swing until well into 2013.
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[Editor's note: Last month in Case Management Insider, we started our discussion on the case management process. We reviewed the first two steps in the process which were "selection and screening" and "patient assessment and diagnosis." In this month's edition we will continue to review the steps that case manager's use in their daily work to achieve positive outcomes for their patients and their organizations.]
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By centralizing the patient transfer process, Baylor Health Care System, with headquarters in Dallas, has made it easier for patient to transfer from one hospital to another and facilitates communication between clinicians.
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It must seem as though the number of important things to read and digest that come across a quality manager's desk is never-ending.
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Select Health of South Carolina is collaborating with community partners to ensure that pregnant women in their First Choice health plan's Medicaid population have full-term, healthy babies.
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Emergency department administrators are well aware that crowding in the ED is associated with poorer patient outcomes, longer hospital stays, and decreased patient satisfaction.
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The old saying "An ounce of prevention is worth a pound of cure," couldn't be more appropriate than when it comes to preterm births.
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By meeting at-risk pregnant women face-to-face in their physician's office, a case manager from BlueCross BlueShield is able to successfully engage the Medicaid recipients in case management and work to meet their needs throughout the pregnancy.
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Passport Health Plan's Mommy Steps program helps at-risk pregnant Medicaid recipients get the care and psychosocial help they need to overcome the obstacles to a healthy pregnancy.
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UCLA Health System in Los Angeles reduced length of stay and improved patient throughput by using a "strategic triad" of initiatives that includes interdisciplinary rounds, clinical high-risk meetings, and use of escalation to overcome barriers to discharge.