Hospital
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Teaching Situational Awareness, De-escalation Techniques
Violence at some level is intrinsically unpredictable, but there are practical methods and techniques workers can be trained in to prevent events — and minimize the effect of events that do occur.
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California Violence Prevention Law Sets New Standard for Nation
Hundreds of hospitals and other healthcare facilities in California are implementing a statewide workplace violence law, with an April 1, 2018, deadline looming to have a written prevention plan in place. Implementing the requirements of the state law — California SB 1299 — are proving challenging at some facilities.
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Hospital Standardizes Debriefing After Critical Events
The maternal and fetal medicine team at Sharp Grossmont Women’s Health Center, affiliated with Sharp Grossmont Hospital in La Mesa, CA, improved quality of care recently by implementing a standardized debriefing process for critical events.
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Patients Threatened by Gaps in Care When They Change Settings
Patient safety and quality of care are threatened when patients move from one setting to another, but there are strategies that can address those gaps in care.
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Revenue Cycle Team Optimizes Reimbursement
If a hospital doesn’t have a revenue cycle management committee, case managers can approach leadership and suggest that they propose that the hospital administration create a committee to review all contracts and denials.
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Large Caseloads Make Denial Prevention Difficult
Hospitals that pile task after task on case managers and assign them large caseloads are unlikely to effectively manage denials.
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Be Knowledgeable About Hospital’s Payer Contracts
To prevent denials, case managers must know the requirements of each individual payer. But at some hospitals, the finance and/or managed care departments don’t provide case management with the utilization review section of the contract where the rules are outlined.
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How to Avoid Four Types of Denials
Case managers must take a proactive approach to reducing the denial rate — and the best way to do it is to prevent the denial.
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Types of Case Manager Reviews
This chart shows the types of payer reviews case managers typically perform.
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When Managing Denials, the Best Defense Is a Good Offense
Denials represent a significant amount of lost revenue. Case managers should take an active role in preventing and managing denials.