By attending this session you will be able to ensure that you understand the compliance issues directly related to the practice of case management and that you have incorporated them into your daily practice. Compliance includes documentation and communication with the patient and family as well. Be sure that your processes are hard-wired and part of your daily routine.
Objectives of the Presentation:
- Understand the compliance issues required under the Conditions of Participation for Utilization Management and Discharge Planning
- Describe your responsibilities as they relate to Observation and the 2-Midnight Rule
- Your requirements to be compliant with the Important Message from Medicare
- Explain how the patient choice lists are used
- Understand the different types of HINNs and when they should be given
- Document for compliance
Why Should you Attend:
As case managers, we must be aware of the myriad of compliance issues that we must adhere to in our daily practice. Never has this been more important to our work as case managers then it is now. Our ability to remain compliant has become an element of audits from accrediting bodies such as the Joint Commission as well as the Centers for Medicare and Medicaid Services (CMS). It is the right thing to do for patients as well.
This program will review the compliance issues that most greatly impact your practice such as the 2-midnight Rule, the NOTICE Act, HINNs, The Important Message and others. The Joint Commission is now monitoring these issues when they have deemed status from Medicare, so your compliance is critical to a good Joint Commission survey outcome. This program will help you to identify where you may have compliance practice gaps as well as how to fix them!
- Compliance overview for case managers
- Balancing quality and cost
- The Conditions of Participation
- Compliance at the access points
- The 2-Midnight Rule and Observation
- The NOTICE Act
- The Important Message from Medicare
- The HINN
- Changes in Patient Choice
- Utilization management and compliance
- Documenting for compliance
- How to perform a compliance gap analysis
- Compliant UR Committee
Case managers and social workers need to maintain compliance in a number of areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments for compliance with the Conditions of Participation as well as other regulatory requirements. Every case management professional needs to know how these requirements impact their professional.
Dr Toni Cesta,
Consultant and Owner ,
Case Management Concepts, LLC
oni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, with an eye on structure, process and outcome measures for nurse case managers and social workers.
The author of nine books and a frequently sought-after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Among her books are included the “The Case Managers Survival Guide” and “Core Skills for Hospital Case Managers”.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management. She is a past commissioner for the Commission for Case Management Certification. She has held positions as Senior Vice President, Corporate Vice President, Director of Case Management and professor of case management.
Who will Benefit:
- Director of Case Management
- Compliance Officer
- RN Case Managers
- Director of Quality Management
- Director of Social Work
- Social Workers
- Physician Advisor
- Case Management Senior Leaders
- Directors of Finance
- Director of case management
- Case managers
- Directors of nursing
- Directors of patient flow
- Director of revenue cycle
- Chief financial officers
- Chief operations officers
- Chief medical officer
- Nursing home directors
- Director of home care