Do you find yourself wondering which five clinical conditions are appropriate for inpatient billing even without a two-midnight expectation?
Maybe you're asking yourself if a patient with a TKA (total knee arthroplasty) can start with an outpatient status and then change to inpatient if there are complications?
In today's unforgiving healthcare environment, you need to know the correct answers to these and other questions about patient status. Not knowing could cost your facility—denied claims and a potential loss of reimbursement.
Case managers of all experience levels find it challenging to keep up with the rules surrounding patient status. Changes in the Outpatient Prospective Payment System (OPPS) from the Centers for Medicare and Medicaid Services (CMS), recommendations from Quality Improvement Organizations (QIOs), and state-specific regulations associated with Medicaid have made status assessments much more complicated than simply understanding the CMS two-midnight rule.
Seasoned case managers who have solidified their understanding of the CMS two-midnight rule since it was created in October 2013 may become frustrated with the newest caveats which do not require an expectation of two-midnights or even their passage. Brand-new case managers just through training may be confused by recent articles or webcasts they have seen which appear to offer conflicting information. This webcast will provide much-needed clarity to both ends of the experience spectrum.
Utilization optimization is another key component of the RN case manager's role. Often, scenarios which occur with relative frequency within the hospital setting are assumed to be acceptable without a second thought. After this webcast, you'll notice that some common situations which reflect "what we've always done" are, in fact, serious transgressions which negatively affect patients, health systems, and even individual physicians.
Highlighting specific case scenarios, this webcast will clearly map-out the essential points everyone involved in hospital case management and utilization needs to know to be effective in their role.
Why This is Relevant:
The ever-changing and evolving rules of patient status make it very difficult for case managers and others to keep up with what is current and actionable. Likewise, it is even more challenging to keep the medical staff up-to-date with what they need to know about these topics. This webcast will be a no-nonsense review of the imperative topics and how to use them on a daily basis utilizing real-world case examples.
During this exclusive RACmonitor webcast with Dr. Juliet Ugarte Hopkins, you will…
- Understand the difference between the "two-midnight" and "3-day SNF" clocks in addition to other possible time-related clocks associated with your state's Medicaid plan;
- Learn about clinical scenarios where the Medicare two-midnight rule does not apply;
- Know the most effective methods to educate physicians about the clocks and caveats to status determinations;
- Learn about those situations which might be accepted or routine within your health system but are actually utilization problems which should be addressed; and,
- Discover how you can help your health system identify and address utilization opportunities lurking in plain sight.