Case Management Boot Camp Series changes in 2019

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

The world of healthcare is changing rapidly and so is the role of case management in that world! Federal fiscal year 2019 promises to bring new and exciting changes that will impact your work as a case management professional. Whether you are reading or hearing about value-based reimbursement, the Affordable Care Act, the continuum of care, bundled payments, transitions in care, or accountable care organizations, case management is at the center of it all!

Because things are changing so rapidly it can be a challenge to stay current and knowledgeable in the issues that most greatly impact your role as a case manager. Each year we bring you the latest and greatest in the field of acute care case management. We hope to do the same for you again this year! Reimbursement has changed dramatically as has utilization management, transitional planning and compliance. CMS has incorporated changes that impact on payments related to readmissions, length of stay and the cost of care. Who is in a better place to address these issues than case managers! Finally, how do you measure your impact on the cost and quality of care and the reimbursement your organization receives for that care?

All these topics and more will be covered in this jam-packed five-part series. The program will start with an overview of the state of the art in case management today, how we got here, and where we are going in the future including a review of acute care reimbursement. From there we will discuss the often-confusing subject of all the roles that occur in best practice departments. You will learn more about the complimentary, but separate roles of RN case managers and social work case managers. From there, we will address best practice case management department models. We will then review what utilization management and transitional planning really mean under the current CMS rules and the new CMS proposed rules. We will end our series with a discussion on the best ways to measure the outcomes of your case management department and its impact on the organization.

Whether you are new to case management or a seasoned pro, this webinar series will provide you with the latest and most up-to-date topics and information that you will need to be at the top of your game and produce the best outcomes for you, your patients and your organization.

Part I : A Review and Preview of Acute Care Case Management and Reimbursement Strategies for 2019 (90 Mins) (On demand Available)

- 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!

Part II : Acute Care Case Management Roles, Models and Staffing Ratios: Who Does What and When? (90 Mins)(on demand available)

- Standards of case management practice - Definitions of case management - Statement of philosophy
- Guiding principles - Patient flow - Utilization and resource management
- Denial management - Variance Tracking - Transitional and discharge planning
- Integrating case management roles - Skill sets - The case management process
- Case management models - Pros and cons of different models And more!

Part III : Utilization Management: What Does it Really Mean? And Where Should it Reside? (90 Mins) (On demand Available)

- Utilization management definition - Medical necessity defined - Compliance components of medical necessity
- Billing and reimbursement - Best practice in clinical reviews - Managing utilization from the bedside
- Appropriate UM documentation - Proactive denial management And more!

Part IV : Discharge And Transitional Planning Under The Current and Proposed CMS Rules (90 Mins) (On demand Available)

- Transitional planning as a process - Case management transitions - Admission assessments
- Social work triggers - Home care triggers - Influences on transitional planning
- Discharge planning compliance - Next level of care providers - Hand-off communication
- Transitions time-outs - How to hard-wire your processes And more!

Part V : Measuring The Success Of Your Case Management Department: Do You Make the Grade? (90 Mins) (On demand Available)

- Define outcomes - Quality outcomes - Cost outcomes
- Case management outcome levels - Departmental goals - Productivity measures
- Where do you find benchmarks? - Managing avoidable delays And so much more!

After this webinar participants will be able to:-

  • Understand how hospital stays are reimbursed under the DRGs and prospective payment.
  • Review managed care, the different products and what case management’s role is.
  • Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).
  • Understand the changing roles of case management professionals across the continuum of care.
  • Understand the role evolution of case managers.
  • Describe the different skill sets and roles of RN case managers and social work case managers.
  • Review specialty case management roles and determine new or updated roles for your contemporary case management department.
  • Understand the evolution of case management models.
  • Describe the advantages and disadvantages of each model.
  • Identify the best model for to ensure a contemporary case management department.
  • Describe the differences between utilization review and utilization management.
  • Discuss the best strategies for managing utilization reviews and other issues relate to utilization management.
  • Identify ways in which a strong utilization management process can reduce payment denials.
  • Understand transitional planning as a process not an outcome.
  • Discuss the new CMS changes related to transitional and discharge planning and how they can impact your practice.
  • Identify best strategies to transition patients across the continuum of care.
  • Describe contemporary outcome measures for case management.
  • Review how to create a workable case management dashboard.
  • Understand how benchmarks can be applied to your CM dashboard.

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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