A Review and Preview of Acute Care Case Management and Reimbursement Strategies for 2019

Recorded Webinar | Catherine M. Mullahy | From: Jun 24, 2019 - To: Jun 28, 2019

Speaker: Catherine M. Mullahy (RN, BS, CRRN, CCM) and Jeanne Boling (MSN, CRRN CDMS, CCM).

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 managed care and managed care contracting as well as the various managed care products currently on the market. Also included will be a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touch point on the continuum A review of the state of the art in case management from both the acute care and community sides will also be discussed as well as the emerging trends that correlate directly with changes in health care reimbursement over time.

Agenda topics:

- Healthcare industry today - Mandate for change - Medicare
- Medicaid - Managed care definition - Managed care contracting
- Managed care products - The history of case management - The evolution of case management
- Acute care case management - Community based case management And more!

After this webinar participants will be able to:

  1. Understand how hospital stays are reimbursed under the DRGs and prospective payment.
  2. Review managed care, the different products and what case management’s role is.
  3. Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).
  4. Understand the changing roles of case management professionals across the continuum of care.

Target Audience:

Anyone involved with or interested in case management, including but not limited to: CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Department Directors, Quality Improvement Staff, Physicians, Nurses (all levels), Compliance Officers, CMS Liaisons, TJC Liaisons, Registration Staff, Safety Officers and Staff, Pharmacy Staff, Ethics Committee Members, Consumer Advocates, Risk Managers, Legal Counsel, Behavioral Health Staff, Psychiatry Staff, Social Workers, Discharge Planners, Case Managers, Hospice Staff and Regulatory Affairs Staff.

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