Compliance Measures for Case Management Professionals in the Acute Care Setting
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, educating case management professionals and assisting in the implementation of case management departmental changes.
The author of nine books, and a frequently sought-after speaker, lecturer, and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program, and systems process improvement.
Dr. Cesta has also held positions as Corporate Vice President for Patient Flow Optimization and Director of Case Management. She also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
This program will review the compliance issues that most greatly impact your practice as a case management professional such as the 2-midnight rule, the NOTICE Act, HINNs, The Important Message, and others. Do you have a utilization review committee and is it compliant with the Conditions of Participation for Utilization Review? Are you compliant with the Federal rules for discharge planning? Case management in acute care centers has a variety of required areas of compliance. 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 practice gaps as well as how to fix them!
- Compliance overview for case managers
- Balancing quality and cost
- The Conditions of Participation
- Compliance at the access points
- The 2-Midnight Rule and Observation
- The NOTICE Act
- The Important Message from Medicare
- The HINN
- Utilization management and compliance
- Documenting for compliance
- How to perform a compliance gap analysis
- Compliant UR Committee
Course Level - Basic
Who Should Attend
- Director of Case Management
- Director of Social Work
- Case Managers
- Social Workers
- Vice President of Case Management
- Director of Quality
- Nursing Director
- Nursing Vice President
- Physician Advisor
- Emergency department physicians
Why Should You Attend
As a case manager, you may not be up to date on all the compliance issues affecting case managers in the acute care setting. While some of them have been around for years, others are fairly new. Some are directly linked to reimbursement. By attending this session, you will be able to ensure that you understand the compliance issues directly related to the practice of case management and that you have incorporated them into your daily practice. Compliance includes documentation and communication with the patient and family as well. Be sure that your processes are hard-wired and part of your daily routine.
As case managers, we must be aware of the myriad of compliance issues that we must adhere to in our daily practice. Never has this been more important to our work as case managers then it is now. Our ability to remain compliant has become an element of audits from accrediting bodies such as the Joint Commission as well as the Centers for Medicare and Medicaid Services (CMS). It is the right thing to do for patients as well.