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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]
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  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]
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Tom RasmussenTom Rasmussen
Publisher
Athena Forum
Tom.Rasmussen@AthenaForum.com

 
 

NEW courses in Development

» Breast Cancer Care
» Improving Outcomes in ESRD

 

 

Cathy WrightCathy Wright, BSN, RN
Clinical Editor
Athena Forum

Cathy.Wright@AthenaForum.com

 

 

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

Clinical Care Series®
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Care Management Series®

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Behavioral Health Series®

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» Harm Risk Behavior

 

 
 

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