More than 27 million Americans currently do not have health insurance of any kind, and even more are underinsured. But those who do have adequate health insurance are hardly out of the woods. Many current health plans feature massive deductibles. In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the K [...]
Hospital 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.
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Focus on length of stay has been ongoing since 1983. Yet we all know that If cost per case is less than the DRG reimbursement, the per diem rate, the bundled payment, or the value-based benchmark, the hospital achieves a margin no matter what the LOS might be. If quality patient outcomes and financial viability are the hospital's goals, then it's time to switch strategies. [...]
On April 30, 2020, CMS published an interim final rule (IFR) that made regulatory changes and clarified certain policies in response to the Coronavirus (COVID-19) public health emergency (PHE). The IFR’s changes include increased flexibilities for hospitals to provide and receive Medicare payment for hospital outpatient services to patients in their homes. IN DEPTH [...]
We're delighted to feature Glenn Krauss, noted subject matter expert on the practice of clinical documentation and a fearless fighter to help CDI specialists transform their task oriented focus to meet the demands of clear and concise medical documentation in today's marketplace. [...]