Hospital Revenue Cycle – RAC Audits
In the AF course on Hospital Revenue cycle, the history and process surrounding RACs in detailed in Chapter 6. This Medicare review process utilizing Recovery Audit Contractors, allows for audits of Medicare claims for overpayment and underpayment.
Case managers may be involved in appeals management, especially for medical necessity, in several ways.
• Preparing written responses to denials. Focus on clinical perspective. Medicare IP-only list may not be the end of the road with proper documentation.
• Collaboration with coding to determine root cause analysis. Could it be a problem with the way the codes are working in the software? human error? documentation?
• Collaboration with providers. Consider that the providers may be receiving RAC audits in the office setting and may welcome your help.
Athena Forum – Hospital Revenue Cycle, Chapter 6
Multiple Sclerosis – New symptom management drug approved
Athena Forum’s course for MS care recently added information detailing a new medication approved for PBA (pseudo bulbar affect). The medication is Nuedexta™ (dextromethorphan hydrobromide and quinidine sulfate). This neurologic disorder manifests in patients as increased episodes of laughing and/or crying not in connection with the individual’s feelings.
“It is important for family members and caregivers to know this, and realize that people who experience these episodes may not always be able to control their expression of emotions.”
Athena Forum - MS Course, Module C, Chapter 2 Medications Used in MS
|November is COPD Awareness Month
Check out Athena Forum's course on COPD for the latest guidelines and standards of care of chronic obstructive lung disease, based on recent updates from the National Heart, Lung, and Blood Institute and the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD).
More information from the American Lung Association is available here
ALZ.org: Disease awareness in TV programming
As a TV watcher this past month there has been a theme running throughout news and entertainment programming – which has been to increase awareness of Alzheimer’s disease. There have been story lines in dramatic shows, and reports within the evening news. Much of the information is coming as a surprise to many Americans. Alzheimer’s currently impacts 5 million Americans with the diagnosis and up to 10 million caregivers (www.alz.org).
The Alzheimer’s Association offers education for the community, families and caregivers, and the professional community. It is a great resource for finding support, including sought after housing information. You will also find the ’10 signs of Alzheimer’s’ and a Caregiver Resource handbook.
Please visit and learn more at www.alz.org – The Alzheimer’s Association.
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JSPH & Athena Forum – Partners in Chronic Care
Master’s Degree in Chronic Care Management.
Managing chronic illness is the key to true healthcare reform.
No matter what its appearance – diabetes, hypertension, arthritis, cardiovascular disease, asthma, cancer or COPD – chronic disease is the greatest contributor to the cost of healthcare in the United States.
The Jefferson School of Population Health’s online Master of Science in Chronic Care Management (MS-CCM) stresses chronic illness prevention and wellness, integrates evidence-based guidelines, includes behavioral health concerns, and appreciates cultural and individual variation.
The program prepares leaders to critically analyze, design, implement and evaluate systems to improve chronic illness prevention and care management across various health care settings and populations
For more information about Jefferson’s MS-CCM program, click here. 215-503-5305
CM Excellence® Series:
» Principles of Case
» Patient Advocacy
» Utilization Management
» Discharge Planning
» Hospital Revenue Cycle
» Behavioral Health
» Colorectal Cancer
» CV Risk: Stroke & MI
» EOL & Palliative
» GI Disorders
» Heart Failure
» Multiple Sclerosis
» Obesity Management
» Pain Management
» Rheumatoid Arthritis
» Women’s Health
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