Interdisciplinary care rounds are moving front and center as a key strategy for coordinating care, managing length of stay and improving patient and family satisfaction. It is also a component of the Joint Commission’s Safety Standard #2. According to the Joint Commission, best practice for these rounds includes the full interdisciplinary care team with rounds conducted at the patient bedside. Case ma..
The session will provide an overview of the Federal Civil False Claims Act (FCA) and how it works. It will also provide an assessment of enforcement activities, showing how healthcare providers may be at risk. In addition, the session will review recent cases and show how they potentially impact healthcare providers.We will start with a review of the Federal False Claims Act and discuss how it works and how..
The Centers for Medicare and Medicaid Services (CMS) has instituted linkages between cost and quality through value-based purchasing and other cost-saving measures, such as payment penalties for high readmission rates. These changes have created the first links between the cost and quality of health care. These factors now require that case management models begin to change and adapt. The early case managem..
Whether your employer is a clinic, a hospital, home health, or long term care; whether you are an MD, RN, an occupational therapist, a receptionist, or in the C-Suite, approximately 5% - 10% of your patients may be gay, lesbian, or bisexual. Additional patients may be transgender, intersex, or questioning their gender identity or sexual orientation. The healthcare needs of GLBT patients may appear to be the..
This webinar will focus on cases and enforcement actions taken by the HHS OIG and its law enforcement partners in 2023. We will also briefly review the Anti-Kickback Statute (“AKS”), discuss safe harbors, particularly the new proposed safe harbor for coordinated care and associated value-based arrangements, and OIG Advisory Opinions that have been issued in 2023, as well as pertinent cases involving the AKS..
We will review the elements of the physician employment agreement that can cause the greatest problems, focusing on the pitfalls and the complications that can develop when the parties do not fully understand what is being agreed to. Such items as corporate practice, term and termination, termination for cause, duties of the physician, call, non-compete clauses, and compensation are all items that should be..
Foundations in Case Management: Medicare Reimbursement, Value-Based Purchasing, Bundled Payments and More
This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. Included in this will be a review of the DRG relative weights, case mix index and expected lengths of stay. Medical record coding will be explained in the context of how hospitals get reimbursed. This will be followed by a discussion of man..
This webinar will discuss and review the expected outcomes of a contemporary case management department. Also included will be a discussion as to how to align these outcomes with the hospital’s strategic plan. This is vital in an era of healthcare reform where quality and cost outcomes affect the hospital’s reimbursement and publicly reported data. Designing a case management report card has to start with t..
Case management models in the acute care setting are constantly evolving and improving. So is true for case management in the emergency department. RN and Social Work case managers working in this fast-paced setting must evaluate patients who will be treated and released, those being placed into observation and those being admitted to an inpatient bed.Therefore, it is imperative that the ED case management ..
Most disciplinary policies are progressive. A progressive policy applies increasingly more severe sanctions to additional incidents of bad behavior. It is very important that the organized medical staff have a disruptive practitioner policy. This webinar will discuss the development of such a policy, including what it should include, and how it should be implemented. It is also important to unde..
Because the Anti-Kickback Statute is so broad it what it proscribes, healthcare organizations, conducting what would be normal marketing activities in other industries, have run afoul of the Statute on numerous occasions. The Statute and the regulations only tell part of the story. This program will review not only the Statute and its safe harbors but will provide an in-depth overview of OIG guidance and ad..
This webinar will discuss the Health Care Quality Improvement Act (HCQIA) in detail, including the standards that must be met to achieve immunity under the act. The HCQIA itself will be reviewed, including a detailed look at the Congressional purpose for the act. The legislative history of the act will be reviewed to gain an understanding of the intent of Congress in passing the actNext will be a review of ..
Access Point Case Management: Managing Your Routes of Entry While Maintaining Compliance with the 2-Midnight Rule
In this webinar we will explore the unique roles of the ED and admitting office and transfer center case managers and social workers and how an initial assessment and clinical review can better ensure that patient are placed in the correct setting right from the get-go. We will review the 2-midnight rule and the part that case management plays in managing it. This can better ensure a reduction in use of Con..
This program will review the elements that most greatly impact on cost and length of stay by focusing on care coordination as one of the key strategies for successful reductions of these metrics. Even CMS’s Spending per Medicare Beneficiary Measure, also known as the Efficiency Measure, holds your hospital accountable for these metrics. Care coordination, as one of the main roles of the RN case manager, is ..
This program will review the compliance issues that most greatly impact your practice such as the 2-midnight Rule, the NOTICE Act, HINNs, the important message and others. The joint commission is now monitoring these issues when they have deemed status from medicare, so your compliance is critical to a good joint commission survey outcome.This program will help you to identify where you may have compliance ..