More than one-third of Americans are obese, according to the Centers for Disease Control and Prevention. These individuals typically have a higher risk of numerous health conditions, such as heart disease, stroke, diabetes, and certain types of cancer-conditions that can all lead to higher rates of complications and readmissions.
If your utilization review (UR) committee is like many others nationwide, it may not have actually met in years-and chances are your UR committee members are secretly glad that's the case. Let's face it; those meetings can be a complete snooze.
Just a few years ago, few employers required certification for new case managers. Today, more than one-third seek this stamp of approval when they bring someone new on board.
Improving the hospital experience for patients, improving the quality of care, and reducing costs were the goals when case managers at Martin's Point Healthcare in Portland, Maine, stopped working independently and started working as teams.
Physician advisors provide a critical link between case management and physicians; it's a position that requires deft communication skills, regulatory know-how, and a stiff backbone.
For many patients, home health services can mean the difference between a successful recovery and a hospital readmission, but patients who need services go without because of confusion over eligibility requirements.
Editor's note: Each year HCPro's Revenue Cycle Institute reports on the experience of providers related to the Recovery Audit Program. The article below is adapted from the 2011 Recovery Auditor Benchmarking Report, released in early 2012. The summary of last year's results is by Kimberly Anderwood Hoy, JD, CPC, director of Medicare and compliance at HCPro. Readers can download their complimentary copy of the full report at www.revenuecycleinstitute.com.
Leaders there established multidisciplinary barrier reduction teams (BRT) in late 2009, which are designed to increase efficiency and improve communication at the organization. The teams give staff members a way to speak up about issues that may hinder patient care and the discharge process.
