CMSA Revises Standards of Practice Again
The Case Management Society of America (CMSA) issued revised Standards of Practice for Case Management in 2022. [...]
Case Management Advisor
Most Recent Updates
by Phoenix Medical Management, Inc.
The rapidly evolving marketplace requires new competencies to effectively manage high-risk and at-risk patients as they navigate the acute and post-acute episodes of care. The models of the 1990s must be transformed to accomodate the expectations of new ACOs, risk based contracts, bundled services, patient centered care, and new delivery of care settings.
We welcome your thoughts or your critique. Feel free to send an email to editor@phoenixmed.net.
Making Meaning out of Avoidable Days: Part II
Is it the SNF or is it the payer? [...]
HINN 12 and What is Next After A Medicare Patient Has Appealed Their Discharge
One cannot place liability on the patient without a safe discharge plan in place. [...]
Should I Hire Someone Without Case Management Experience?
Healthcare has gone through so many changes in the past three years. [...]
Why Is That Patient Still Here?
As case managers, we have all heard the question, “Why is that patient still here?” [...]
Making Meaning Out of Avoidable Days
Avoidable days can impact patient care and social determinants of health (SDoH). [...]
Report: U.S. Charity Care Provided by Hospitals Leaving Much to be Desired
Healthcare provided to the most vulnerable populations often constitutes a tiny sliver of overall hospital budgets. [...]
Final Rule on Rural Healthcare Services
Release of the REH designations for 2023, indicates that CMS will only be covering outpatient, emergency, and observation care services. [...]
Why Has the Hospital Turned into Long-Term Care?
Often, the ability to move such a patient from the hospital into an appropriate setting is dependent on the social services in the local jurisdiction. [...]
How to Integrate a SDoH Coding and Quality Question
Quality reporting will be mandatory in 2024, and then under a payment determination in 2026. [...]
New Hospital Reporting Requirements for SDoH
CMS has implemented two measures under its Hospital Inpatient Quality Reporting program. [...]
Looking to the Future: Striving for More Than Just Discharge Planning
I can remember when the movement of coordinating the progression of care became the hot topic for acute case management... [...]
SDoH at the Intersection of Language and Healthcare
This story is in recognition of National Hispanic Heritage Month. [...]
Money Follows the Person
Understanding Medicaid’s Money Follows the Person (MFP) demonstration. [...]
SDoH at the Intersection of Healthcare Quality
Discussion around using Z codes to capture SDoH data [...]
SDoH Recognized in the 2023 IPPS Final Rule
Some SDoH conditions are more likely than other to be impactful on healthcare consumption. [...]
SDoH at the Intersection of Skilled Nursing Facilities
Are SNFs taking advantage of the PHE waiver? [...]
Enforcers Target Discharge Planners/Case Managers Yet Again
Case managers/discharge planners continue to come under fire from fraud enforcers for violations of the federal anti-kickback statute. [...]
SDoH: How Safer Communities Act Can Provide Additional Funding
From my June 13 Monitor Mondays segment on the impact of gun violence on healthcare to the time I researched for this segment, there have been 67 deaths and 404 injuries. [...]
Telehealth at the Intersection of SDoH
Two years later, there are some changes to telehealth. [...]
Medicare and Maryland: Lessons Learned
Maryland Total Cost of Care (TCOC) Model was developed by the CMS Innovation Center. [...]
MACPAC Addresses SDOH for Medicaid Recipients
Benefits are largely dictated by how each state manages its Medicaid program. [...]
Staffing Acute Care Facilities in 2022
How we can face recruitment and retention strategies in a post-COVID era. [...]
Mental Health Awareness & Honoring our Healthcare Workers
Healthcare workers deserve more than parties and snacks. [...]
IPPS and Maternal Health
The U.S. has the highest rate of maternal deaths among high-income countries. IPPS has set new standards in the 2023 IPPS ruling that could impact maternal care designations. [...]
Palliative Care a Win for Both Patient and Hospital System
Palliative care does not always equal Hospice, and can provide success for both the patient and the hospital system. So, the topic to consider is, how do we involve palliative care and how can it improve the patients’ transition of care? [...]
IPPS and the Social Determinants of Health
CMS, in its IPPS proposed rule, is asking for comments about SDoH codes. [...]
SNF and the Social Determinants of Health
Impact on SNFs was foreseen in the IPPS proposed rule. [...]
What to Do With the Complex Patients
Hospitalizations appear to be more complex, requiring greater attention from the multidisciplinary team. [...]
Gaining a Better Understanding of Advance Directives and Medical Necessity
Health systems should consider not only the ailment inflicting the patient, but the person being impacted by this care and what this means to them. [...]
The Nursing Home Crisis Continues to Unfold
The president’s State of the Union address adds a sense of urgency to this crisis in America’s healthcare system. [...]
Findhelp Emerges as Leading Service to Help Providers Address the SDoH
SDoH service is now ranked number one by KLAS Research. [...]
Understanding Healthcare's New Quintuple Aim
The Quintuple Aim requires a dedicated practice to evaluate marginalized populations when considering how healthcare is delivered. [...]
Evaluating outcomes of home health: a comparison of rural and urban settings
The Journal of Rural Health published a recent article by the New York University (NYU) college of nursing that is catching some buzz regarding the health disparities between urban and rural settings. The study looked at process and outcome measures over a five-year period, from 2014 to 2018. They compared the two geographic regions across approximately 7,900 home health agencies, looking at the [...]
The Great Exodus is Hitting Case Management
Nurses, social workers, therapists, advanced practice providers, etc. are leaving in droves for a better opportunity that offers flexibility, ability to work from home, better benefits, and higher pay. However, for the staff that are unable to leave their current employer because of personal circumstances, disengagement is at new levels with burnout associated with the ongoing pandemic and subsequ [...]
Short Stay Auditors are on their way: Are you prepared?
Review Dr. Zelem's latest article on RACMonitor, https://racmonitor.com/occurrence-span-code-72-what-is-it/ regarding Livanta's award of short-stay audits and how occurrence span code 72 may ensure you are prepared with appropriate documentation and coding. [...]
How Can Healthcare Systems Continue to Keep up with Challenges Related to COVID?
An examination and account on the continued difficulties of staffing and leadership during COVID times. [...]
Condition Code 44: How many should you have?
Check out our latest article on RACMonitor regarding Condition Code 44s at https://racmonitor.com/condition-code-44-how-many-should-you-have/. Also make sure to check out Dr. Juliet Ugarte Hopkins article “Deconstructing the Concept of Condition Code 44,” which includes a complete history and best model approach to the Condition Code 44 process. [...]
The Breakdown on continued stay reviews
Check out our recent posting on RacMonitor, https://racmonitor.com/gaining-a-better-understanding-of-continued-stay-reviews/, to obtain a better understanding of continued stay reviews. What are they really for? [...]
Building a Partnership with your Hospitalist
Case management can be explained as the hub of the wheel that connects all disciplines to the patient with its primary spoke being the physician. The case management team, including the utilization review specialist can inform and educate the hospitalist on access, progress of care and transition opportunities that optimize resource utilization. Several avenues can assist in educating the hospital [...]
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Understanding the Surprises in the No Surprise Act
Learn how to prepare for the No Surprise Act, article published on RACMonitor, https://racmonitor.com/understanding-the-surprises-in-the-no-surprises-act/ [...]
Addressing UHCs stance on non-emergent ED visits
Right time, right place, right setting…. well maybe. In UHC’s network bulletin ….that was quickly retracted and held for delay after the AHA and AMA expressed extreme ethical concerns. [...]
Patient billing may have gone too far!
Catch the official report on RACMonitor’s Monitor Monday podcast! Last week Johns Hopkins University released an interesting report to Axios that highlighted the top 100 US hospitals that have accrued revenue by suing patients over unpaid medical bills between January 2018 to July 2020. [...]
Primary Care First makes it easier to integrate care management
A comprehensive care management program can be costly and often not justified with past payment models. However, the PCF model provides a solution for this by offering up-front, partially capitated payments to allow for funding this foundational program. [...]
Medicare Forms: Second IMM & the HINNs
Check out Phoenix Medical Management's latest contribution to the Report on Medicare Compliance regarding all things associated with the Medicare forms. [...]
Understanding Hospital at Home
Review the new provisions and how to participate in the Hospital at Home program. This article published for RACmonitor, https://www.racmonitor.com/understanding-hospital-at-home describes how this program can help in a FFS and value based world. [...]
Connection in Revenue Cycle Improvement
Phoenix Medical Management was able to participate with a small group of experts to discuss how to evaluate and improve the CDI world. Jim shares his white-paper on how an outsiders prospective for process improvement can be applied to clinical documentation integrity. [...]
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Leading Case Management during lock down
The isolation and experience of COVID is something that will unite us all as something we will never forget. Marie shares her accounts while hospitals were on lock down, what leading a case management program was like. [...]
CMS to Resume Surveys
This is a good time to ensure you are ready for CMS to walk through the hospital doors. [...]
Fraud and abuse in the form of free discharge planning
Many case management departments will allow post acute providers to support the discharge process in order to gain referrals. However, this comes at a big risk. CMS requires that patients are provided choice and quality data regarding options for home health, post acute, and hospice. Hospital case management departments will want to ensure that they are compliant when they allow vendors through [...]
OIG Report: Data brief with concerns for potential upcoding
The OIG found a 20% increase in the number of stays for the highest severity level, nearly accounting for half of all Medicare inpatient spending. At the same time, the average length of stay decreased for these high severity stays. [...]
Gatekeepers of the ED
Examining your front end revenue cycle process by positioning CM and UR in the emergency department. Article published on RacMonitor, https://www.racmonitor.com/gatekeepers-of-the-ed [...]
How can unit-based leadership improve performance metrics?
On January 12, 2021, Taylor & Francis, published in the Journal of Hospital Practice, the Impact of a hospital unit-based leadership triad on key performance metrics. They discovered that having physician, nursing, and case management leadership empowered and aligned in the same metrics for performance they were able to achieve improvements in length of stay and progression of care metrics. [...]
Understanding your Readmissions: How to Reduce Penalties?
Readmissions affect 18.2 percent of Medicare beneficiaries. Article originally posted on RACMonitor at https://www.racmonitor.com/understanding-your-readmissions-how-to-reduce-penalties [...]