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If case managers see a problem in their hospital, they have a responsibility to report it, asserts Alice Gosfield, JD, of Alice G. Gosfield and Associates, a Philadelphia law firm.
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As the federal government, private payers, and accrediting agencies crack down on overutilization, underutilization, fraud, and abuse, hospital case managers need to keep an even closer eye on what is going on in their hospitals, experts say.
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These highlights of the final Emergency Medical Treatment and Labor Act (EMTALA) rule were summarized by the Centers for Medicare & Medicaid Services (CMS).
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There is much to rejoice about in the final rule of the Emergency Medical Treatment and Active Labor Act (EMTALA), with many of the most vexing parts of the law either clarified or eliminated altogether, but there still is plenty to keep you busy.
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As Mindy Owen, RN, CRN, CCM, travels around the country for the Commission for Case Manager Certification (CCMC), shes always surprised to find how few case managers are familiar with the standards of practice under which they operate.
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If you think your hospital doesnt have a problem with denials, then you arent doing enough to track them, says Christine Collins, CHAM, director of patient access for Brigham & Womens Hospital in Boston.
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Wouldnt you love for emergency department (ED) nurses to have a quick, easy way to access department policies, updates, drip charts, dosing protocols, telephone numbers, and procedures for infrequent ordering processes?
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Health care providers have access to plenty of flowcharts and algorithms designed to guide the treatment of patients with particular diagnoses, but many of them arent designed for use in the emergency department (ED).
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A case management program for newly diagnosed breast cancer patients at MeritCare Health System in Fargo, ND, helps women smoothly navigate through the health care maze as they make treatment decisions.
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Since Hurley Medical Center in Flint, MI, began a comprehensive program to improve documentation, reimbursement has improved and the hospitals severity of illness and risk of mortality data have come in line with benchmark data.