Monday Memo
Monday Memo
Monday, May 16, 2016
What's NEW at Athena Forum

Announcing Release of Updated UM Course

We are pleased to announce that today, Monday, May 16, 2016 the updated Utilization Management (UM) course will be published on the Athena Forum website.

The course renovation includes expansion to five modules and provision of ANCC certified CE.

The five modules include:

Module A- Dynamics and Structure

Module B- External Forces

Module C- Electronic Info Tech

Module D- Transdisciplinary Care

Module E- Key Quality Measures

[Athena Forum News, May 16, 2016]


Tips from our featured course

Case Management as a Revenue Protector -
The Benefits of an Effective UM/UR Team

Whether the patient has Medicare, Medicaid, commercial insurance or is uninsured, effective UM will ensure that across the continuum of inpatient and outpatient care, the healthcare entity will be reimbursed the maximum amount eligible for the patient's care.

Ineffective UM results in reduced or denied payments due to incomplete, inappropriate or ineffective clinical documentation justifying the delivery of care.

Effective UM processes ensure appropriate reimbursement (financial resources) and support the efficient expenditure of these resources.

[UM, Module A, Dynamics and Structure]


Oversight and RAC Activity

The Tax Relief and Health Care Act (TRHCA) of 2006 made permanent the Medicare Recovery Audit Contractor (RAC) program to identify improper Medicare payments in all 50 states. This includes both:

  • Overpayments
  • Underpayments

As required by The Tax Relief and Health Care Act of 2006, the RAC program was implemented in all 50 states.

RACs cite inpatient coding error as the most common reason for complex claim denials.

[UM, Module B, External Forces]


Notice from the Publisher

I want to thank our 20,000 healthcare professionals for requesting new topics on Athena Forum.

Thomas A. Rasmussen
CEO & Publisher
Athena Forum Institute

Monday Memo Editor

Cathy Wright, BSN, RN

Clinical Editor

Athena Forum

Contact the Editor


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