At many hospitals the terms Utilization Management (UM) and Utilization Review (UR) are used interchangeably. Are they the same thing? No, they're not, according to Stefani Daniels, RN, MSNA, ACM, CMAC, and Ronald L. Hirsch, MD, FACP, CHCQM.
Case management in Alaska isn't for the faint of heart, according to Randi Ferrare, RN, BSN, interim director of case management and social work at Providence Alaska Medical Center. Some of the challenges force case managers at Providence Alaska to work a little harder and get a little more creative to meet the needs of its patient population. One innovative program at the hospital is its case management educator position.
When the placement agency called and said it was looking for an interim case management director in Alaska, and asked if she was interested, Randi Ferrare, RN, BSN, hesitated for just a moment.
Mergers and acquisitions in the healthcare industry are often decided upon and negotiated by C-suite staff with involvement from security and IT professionals. However, significant security implications must be considered by both parties prior to, during, and after a merger or acquisition.
Conducting pre-billing audits can be challenging, but when done correctly, it can save organizations from spending time recoding and rebilling claims that payers deny. These audits can be conducted on the front end, in both inpatient and outpatient settings, once records have been coded.
Lately I've received a lot of questions from hospitals about how to determine when and if it's appropriate to report an E/M visit code on the same date of service as a scheduled procedure.
