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The administration at Scottsdale (AZ) Healthcare System thinks it so important for the Important Message from Medicare (IM) to be delivered correctly that all case managers go through extensive training on when and how the IM should be given to patients.
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The role of the hospital case manager has taken many twists and turns over the past two decades. Case management started out as a sectioned-off role of utilization review without any relationship to the direct care providers or interdisciplinary care team.
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In the newly revised Discharge Planning Interpretive Guidelines, the Centers for Medicare & Medicaid Services (CMS) includes what it calls "blue boxes" that advise hospitals on best practices in discharge planning and care transitions.
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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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When hospitals determine that the care patients are receiving or are about to receive will not be covered by Medicare because it is not medically necessary, not delivered in an appropriate setting, or is custodial in nature, the hospital should provide the patient with a Hospital-Issued Notice of Noncoverage (HINN) to inform them that they will be responsible for the bill if they choose to stay in the hospital.
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When Patewood Memorial Hospital in Greenville, SC, opened six years ago, the hospital administration recognized an opportunity to provide care that was centered around the patients and family members experiences, or patient-centered care, says Beverly Haines, MNEd, BRN, NE-BC, president of the 72-bed surgical hospital, which is part of the Greenville Health System.
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In the last two issues of Case Management Insider, we discussed issues associated with identifying and monitoring patient flow. This month we continue our discussion with a focus on the elements of patient flow associated with the inpatient setting. These issues relate directly to the provision of care as well as the progression of care for patients as they move through the acute-care continuum.
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As the Centers for Medicare & Medicaid Services (CMS) Value-Based Purchasing program moves toward basing reimbursement on quality, case managers can take the lead in making sure their hospitals score well and dont lose reimbursement.
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Gundersen Healths integrated care coordination program, in which a team of RN care coordinators and social workers follows the 1% to 2% most complex patients through the continuum, has resulted in a 46% decrease in average length of stay and a 64% decrease in unplanned hospital admissions or emergency department visits.
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A proactive approach to the Recovery Auditor (RA) process has paid off for Alamance Regional Medical Center in Burlington, NC. Out of more than 800 denials from the auditor, the hospital has appealed up to the administrative law judge level, if necessary. So far, the hospital has won a high percentage of the appeals. Many are still pending because of a backlog.
