Monday Memo  

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Monday, May 11, 2015
  Clinical Accuracy Spoken Here  

News from Athena Forum:
Addressing Regulatory Compliance

“Athena Forum will introduce a new course next month to help hospitals and health systems avoid fines for regulatory failures, called CM Power®. This course will give case managers, nurses, and social workers the education they need to help ensure that their health systems are in strict compliance with regulations on medical necessity and appropriate billing.”

“Athena Forum’s CM Power course will be like the MBA of case management by offering more than 300 pages of sophisticated training designed to improve organizational performance,” comments Tom Rasmussen, Athena Forum’s publisher.

[Reference: Tom Rasmussen, Editor and CEO, Athena Forum Institute]

  Excellence in Case Mgmt  

HRC: Improving Compliance -
Eliminate PADs

Hospitals are always concerned about length-of-stay data and how potentially avoidable days (PADs) impact that number. It is a gauge of how well we are moving patients through the hospital system and may impact contract negotiations as well as customer satisfaction and out-of-pocket costs.

From the fiscal side, if the hospital is being paid based on a fixed payment, avoidable days are at the hospital’s risk. If the reimbursement is based on a per diem, the payer may not pay. PADs drain revenue because they represent costs to the system. The bigger issue is PADs represent a quality problem.

[Reference: Hospital Revenue Cycle, Module B, Hospital Cash Flow]

  Improving Patient Care...  

HRC: Improving Compliance -
RACs Audit Claims

RACs are private contractors performing audits of Medicare claims post-payment to look for and recover overpayments or reimburse underpayments. After successful demonstration projects in four states, the Tax Relief and Health Care Act of 2006 required CMS to make RACs permanent.

During the demonstrations the RACs corrected $1.03 billion dollars in improper payments. RACs review all types of inpatient and outpatient providers.

The Athena Forum Hospital Revenue Cycle course provides a link to CMS for RAC information and updates.

[Reference: Hospital Revenue Cycle, Module A, Industry Cash Flow]


Tom RasmussenTom Rasmussen
Athena Forum


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Cathy WrightCathy Wright, BSN, RN
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