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After a series of delays, the U. S. Department of Health and Human Services has set Oct. 1, 2014, as the firm date for implementation of the ICD-10 procedure and diagnostic coding set.
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Medicare requirements for issuing the Important Message from Medicare (IM) and the Hospital-Issued Notices of Noncoverage (HINNs) have been around so long that they sometimes get short shrift.
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As providers struggle with that small percentage of patients who consume the majority of healthcare dollars, theyre finding that having care coordinators who work face to face with patients often can help patients navigate the healthcare system and follow their treatment plan.
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EmblemHealths team approach to providing face-to-face care coordination after hospitalization resulted in a 31% reduction in the 30-day readmission rate for members who received the interventions when compared to a baseline group.
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In todays climate of healthcare reform and with the growing emphasis on quality, there are more opportunities for case managers than ever before.
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Keystone Mercy Health Plans Acute Care Transitions program, which embeds case managers in hospital emergency departments to work with patients who seek treatment or are hospitalized, reduced emergency department visits by 21% and hospital inpatient admissions by 32% over the course of a year among members who received interventions when compared to a control group.
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Since Tufts Health Plan launched its integrated care management model for Tufts Medicare Preferred, its Medicare Advantage plan, the Watertown, MA, health plan has seen significant reductions in hospital admissions and readmissions.
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While studies show that most people come to the ED because of an urgent or emergent medical concern, some people wind up in an emergency setting because they are not plugged in to the kind of social or medical resources that could more appropriately meet their needs.
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Shift changes are a point of risk in hospital settings because as outgoing clinicians hand off patients to incoming staff, it is easy for important information to be missed or misunderstood. And this risk is heightened in the emergency setting, where providers are working under a constant state of urgency.
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Although all of them qualify for a skilled nursing level of care, 86% of participants in Summit ElderCare are able to live in the community.
