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In the Inpatient Prospective Payment System proposed rule for fiscal 2014, the Centers for Medicare & Medicaid Services (CMS) clarified its long-standing policy on how Medicare contractors review inpatient admissions for payment purposes and continued its emphasis on basing reimbursement on quality.
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The continuing shift toward basing hospital reimbursement on quality emphasized by the Centers for Medicare & Medicaid Services in the Inpatient Prospective Payment System (IPPS) proposed rule for 2014 raises the stakes for hospitals, especially those that treat a lot of Medicare patients.
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At UPMC, an integrated healthcare system with headquarters in Pittsburgh, new case managers spend time on the floor observing a case manager, go through classroom training, then work with a preceptor before going out on their own.
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In the newly revised Discharge Planning Interpretive Guidelines, the Centers for Medicare & Medicaid Services (CMS) includes what it calls "blue boxes" that advise hospitals on best practices in discharge planning and care transitions.
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The role of the hospital case manager has taken many twists and turns over the past two decades. Case management started out as a sectioned-off role of utilization review without any relationship to the direct care providers or interdisciplinary care team.
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The administration at Scottsdale (AZ) Healthcare System thinks it so important for the Important Message from Medicare (IM) to be delivered correctly that all case managers go through extensive training on when and how the IM should be given to patients.
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Use documents as proof you talked to patients
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Continuing to stress the importance of discharge planning and preventing unnecessary readmissions, the Centers for Medicare & Medicaid Services (CMS) has issued a revised set of Discharge Planning Interpretive Guidelines that surveyors will use to assess a hospital's compliance with Medicare's Conditions of Participation. The guidelines do not apply to critical access hospitals, which must follow a different set of Conditions of Participation.
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When two bombs went off near the finish line of the Boston Marathon, hospital clinicians had one thought: I have to get to work. A surgeon who had just run 26 miles came into Beth Israel Deaconess Medical Center and prepared to operate. Nurses and doctors treating the wounded wondered about their own family and friends.
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When hospitals determine that the care patients are receiving or are about to receive will not be covered by Medicare because it is not medically necessary, not delivered in an appropriate setting, or is custodial in nature, the hospital should provide the patient with a Hospital-Issued Notice of Noncoverage (HINN) to inform them that they will be responsible for the bill if they choose to stay in the hospital.
