Hospital
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Surgery Centers Dive Into Bundled Payment Models
In one way, ambulatory surgery centers are perfectly positioned to attract savvy consumers, based on their quality, price, and convenience. But it is not that simple.
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Case Management’s Role in Managing Denials and Appeals in the New Healthcare Environment
Revenue is defined as the sum earned by the provider, measured in dollars. The revenue cycle is defined as the series of activities connecting the services rendered by a healthcare provider with the methods by which the provider receives compensation for those services. Case management plays an integral role in managing revenue and the revenue cycle in the denials and appeals processes. This month, we will discuss the case manager’s role in the revenue cycle as it relates to the management of denials and appeals.
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Nursing Innovation Is Underused and Can Be Leveraged for Career Advancement
Nurses are gaining more stature as potential leaders in healthcare, and much of the innovation in healthcare will come from nurses in the future. Hospitals should work to leverage the innovative potential of nurses, and nurses in the quality field should look for opportunities to advance their careers through this increasingly available pathway.
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Helping Patients Find Motivation to Make Changes
Eat healthy, exercise regularly, and sleep more are healthy goals case managers and nurses reinforce to patients. But case managers often have difficulty living up to their own advice when hectic daily schedules leave little time for healthy pursuits. These goals are so hard to pursue because the benefits are so long-term.
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Avoiding Denials for Transitions of Care
Too often, a patient’s claim for post-acute care is denied for reasons that are entirely preventable. This transition may include either rehabilitation or palliative services in a facility, ongoing outpatient therapy, or care provided at home. These authorizations are scrutinized closely by both payers and regulatory bodies, so it is critical that hospital case managers know how to avoid denials.
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Patient Activation Is a Health Promotion Method That Works
Case managers continually learn new methods to educate and engage patients. The key is to find the right method for case managers to achieve their patient education goals. The patient activation measure is based on the theory that there is a great deal of variation in patient activation/engagement in a patient population. Some patients need more support, and should be evaluated to see what works.
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The Inner Workings of a Health Coaching Program
Hospital case managers and others interested in extending case management through the use of student health coaches can implement a health coaching program with a local college. Both hospitals and colleges can benefit from the collaboration.
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Hospitals and Colleges Collaborate in Health Coach Training Programs
Some small-town hospitals and colleges have found a way to provide pre-med, nursing, and allied health undergraduate students with hands-on medical experience that benefits the community. The student health coaches perform case management-type services for at-risk patients. Called health coaches, these students learn skills years ahead of their peers. They receive college course credit and volunteer or internship experience. And, they contribute to positive health outcomes, including keeping patients out of hospitals and EDs.
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New Target May Lead to Chlamydia Treatment Options
Reproductive health providers battle against chlamydia every day, as it is the most commonly reported sexually transmitted infection in the U.S. According to data from the CDC, more than 1.7 million cases were diagnosed in 2017, with 45% among females ages 15-24 years. New research has identified a potential target for drug treatment that may help develop alternate approaches to stem infections.
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HIV Screening, PrEP Receive USPSTF Recommendation
The U.S. Preventive Services Task Force (USPSTF) has issued final recommendations that providers screen for HIV in everyone ages 15-65 years, and all pregnant women as well as younger adolescents and older adults at increased risk for HIV. Pre-exposure prophylaxis (PrEP) also should be offered to people at high risk of HIV, USPSTF recommends. Since 2006, the CDC has recommended universal HIV screening at least once for people ages 13-64 years, with annual or more frequent rescreenings for persons at increased risk. However, new data indicate that such recommendations have not been fully implemented.