Learn how to prepare for the No Surprise Act, article published on RACMonitor, https://racmonitor.com/understanding-the-surprises-in-the-no-surprises-act/ [...]
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 firstname.lastname@example.org.
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. [...]
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. [...]
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. [...]
Check out Phoenix Medical Management's latest contribution to the Report on Medicare Compliance regarding all things associated with the Medicare forms. [...]
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. [...]
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. [...]
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. [...]
This is a good time to ensure you are ready for CMS to walk through the hospital doors. [...]
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 [...]
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. [...]
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 [...]
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. [...]
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 [...]
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 [...]
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. [...]