Monday Memo  

Weekly update from...
Athena Forum logo

Monday, May 18, 2015
  Clinical Accuracy Spoken Here  

AF News: Addressing Regulatory Issues

Athena Forum will introduce a new course next month to help health systems avoid fines for regulatory failures.

This new course, CM Power®, will give case managers education to help ensure that their health systems are in strict compliance with regulations on medical necessity and appropriate billing.

"The 7,000 pages of Athena Forum's online education programs explain that case managers, nurses, and social workers need to work closely with billing departments and senior staff to ensure that all care is appropriate and medically necessary", says Mindy Owen, RN, CRRN, CCM, contributing faculty for CM Power®.

[Athena Forum Institute, Rockville, MD, May 2015 Press Release]

  Excellence in Case Mgmt  

Discharge Planning:
Accreditation and Economics

According to the Conditions of Participation (CoPs), the hospital must identify at an early stage of hospitalization all patients who are likely to suffer adverse health consequences upon discharge without adequate discharge planning.

CMS also requires that healthcare providers be accredited through a CMS approved accrediting organization. Most hospitals have a high percentage of Medicare patients and rely on Medicare reimbursement.

On a practical level economic survival is a primary reason for achieving accreditation. Without accreditation, a hospital cannot bill Medicare or Medicaid for services delivered.

[Reference: DCP: Module A - Philosophy and Standards]

  Improving Patient Care...  

DCP: Economics of P4P

Bonuses and penalties are now tied to overall Medicare spending and performance based quality measures with:

  • Bonuses for exceeding quality of care measures and/or lower cost per patient
  • Penalties for lower quality and/or higher cost per patient.

Some experts believe that attempts to pay for value have been isolated at state, local, and regional levels. Lessons learned from failures are starting to be addressed.

Pay for Performance (P4P) efforts typically do target hospitals and large physician groups, tying parts of reimbursement to reporting quality and cost information, in addition to providing care based on quality outcome measures (= performance).

[Reference: DCP: Module C - External Forces]


Tom RasmussenTom Rasmussen
Athena Forum


NEW courses in Development

» Breast Cancer Care
» Improving Outcomes in ESRD



Cathy WrightCathy Wright, BSN, RN
Clinical Editor
Athena Forum




Online CE for RN, CCM & LSW
4,000 pages of clinical excellence.

Clinical Care Series®
» Asthma
» Colorectal Cancer
» CV Risk: Stroke & MI
» Diabetes Mellitus
» Ebola Care
» EOL & Palliative Care
» GI Disorders
» Heart Failure
» Multiple Sclerosis
» Obesity Management
» Pain Management
» Rheumatoid Arthritis
» Sepsis Care
» Women's Health
» Wound Care & Payments

Care Management Series®

» CM Express®
» Discharge Planning
» Ethics in CM
» Hospital Revenue Cycle
» Patient Advocacy
» Population Health
» Professional Identity
» Utilization Management

Behavioral Health Series®

» Abuse
» Depression 2.0
» Harm Risk Behavior



Athena Forum Help Desk
Mon-Fri 9am-5pm ET

Recommend to a friend
Tom Rasmussen, Publisher

Enrollment & passwords
Janice Graham, Registrar

  Monday Memo Archives
Did you miss an issue? Need to look up a reference in a past Monday Memo? All past issues are archived for your use. Click here.

Athena Forum, LLC awards CE for ANCC - NASW - CCMC

Athena Forum is a world wide service mark in nursing education
by the U.S. Office of Trademarks and Patents.

Copyright 2012 All rights reserved | Headquarters in Boca Raton, FL | 800-583-2506 | www.athenaforum.com