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Risk Assessment Tool Helps Identify People in Need of Case Management
The Valley Risk Assessment Tool, created by The Valley Hospital of Ridgewood, NJ, is a two-page, two-column chart that assigns a level to each category of risk.
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Payers, Hospitals Disagree About Whether Patient Meets Inpatient Criteria
Payers are refusing to pay claims for gastric bypass, joint replacement, and even cataract extraction. Why? Because documentation in the record does not support the need for surgery.
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Tips to Improve Quality and Efficiency in Case Management Departments
One of the first steps to streamline case management operations is to reassign staff to new roles, such as focused discharge planning jobs and utilization review.
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Missing Clinical Documentation Reason for Many Claims Denials
More health plans are asking for certain pieces of clinical documentation before paying claims. If it is not there, the claim is denied. What are the specific issues arising?
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Team-Based Case Management Improves Care Coordination
A health system’s focus on revamping its care coordination led to a reduction in some 30-day readmissions, as well as other benefits.
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More Patients Newly Eligible for Medicaid; Many Unaware
Medicaid has expanded in many states so previously uninsured patients can access coverage. However, many may not be aware they qualify. Learn how one health system helps eligible patients enroll.
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Patient Access Leaders Tell Important Stories at Conferences
Hospital leaders may view patient access leaders as operating mostly “behind the scenes.” Presenting at conferences is a great way to change that outdated perception.
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Growing Role for Patient Access: Payer Contract Negotiations
Including patient access in the process is part of acknowledging the ever-expanding importance of front end participation in the revenue cycle.
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Benchmarking: Required Reading
Discovering information that can be used to identify gaps in an organization’s processes to achieve a competitive advantage.
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Cannabinoids for Pain Relief Unproven for Surgical Cases
Surgery centers treating patients who have been using marijuana or cannabinoids for pain relief or nausea are raising questions about efficacy and side effects.