Written by Laura-Jane Evans

Taking the decision to move your loved one into a care home can be really tricky. They might object to the idea, or you might feel that you’re failing in your responsibilities to them. The truth is that the right care home can improve the quality of life for your loved one, and make it easier for you, allowing you to enjoy the time you spend with them rather than filling it with caring tasks. With over 1.3 million residents in care homes in the US, it’s clear that this is a decision many people will have to make at some point.

But choosing the right care home is a crucial part of the process. Every place will offer something slightly different, so it’s important to take your time and consider the options carefully so that everyone is happy. Let’s explore some of the factors you should consider.

Take time to understand what care they need

Sometimes, taking the decision to look at care homes is just the result of deteriorating health, but in many cases, it’s triggered by a feeling of overwhelm following a fall or something similar. This can make it hard to think carefully about what care your loved one needs, and if the home you’re looking at can offer that. If you feel that you need to move your family member urgently, you’ll feel under pressure to choose a place quickly.

However, taking the time to understand the care that they need is really important. Do you need to look for a specialist care home for a certain medical condition? Will they need ad-hoc support or around-the-clock care? Are they likely to need care at night? Will they have the chance to be independent if they want to, or does every resident get treated the same?

You can write down your own answers to these questions, but also make sure to ask your loved one if possible, or any carers you already have visiting on a daily basis. You can then use this list as a criteria for narrowing down your choices.

Consider the future

As well as understanding the care your loved one needs now, you’ll also need to consider what things might look like in the future. Unfortunately, things can deteriorate rapidly, and it might be wise to choose a care home that offers different levels of care as and when needed.

For example, if your relative only needs once-per-day check-ins now, but might need them more regularly in the future, make sure that is an option. It’s highly disruptive to move someone once they’re settled at a care home – and on the other end of the scale, you don’t want to force them to have full-time care and lose their independence if they don’t need it. Independent living is particularly vital for seniors, as it gives them a sense of control and purpose, as well as supporting their memory skills.

Look at the location of any potential care homes

The location of a care home is important for two reasons: proximity to family and friends, and proximity to local services if your loved one is able to use them. Firstly, you’ll want to make sure that your relative can have plenty of visitors if they’d like them, which means choosing a place that’s either close to as many people as possible, or has good transport links to enable them to get there easily. Part of the resistance to moving into a care home sometimes stems from the fear of being isolated and lonely, so do your best to combat this from the start, so it isn’t a barrier.

Secondly, not everyone who moves into a care home needs to remain in their room or in the home 24/7. Depending on their health, they may be able to go on planned excursions to the local town or the surrounding area. Care homes that are close to towns or other attractions are more likely to offer these sorts of trips, so consider this when making your choice. This may make moving into a care home more attractive to your loved one, especially if they can’t currently manage these sorts of trips themselves.

Meet the staff team

If you’re looking at care homes, it’s understandable that you’d want to ensure that the people who are looking after your loved one are kind, well-trained and compassionate. After all, they would be taking your place when you’re not there. So, when trying to decide if a care home is right for your family member, make sure you take the time to speak with the manager of the homes you’re considering, and visit in person if possible.

Care workers need to be dependable, good communicators and trustworthy, so look out for these traits in the staff when you make your visit. If they seem unorganized, unable to answer your questions, or like they’re rushing through their tasks, the home might not be the right fit.

Speak to your loved one

If your loved one is well enough to give input into this decision, then make sure to include them. This is a big change that will impact every part of their life, so whilst you might be taking the lead in making enquiries, they need to feel like they have a chance to contribute to the discussion. No one likes to feel blindsided, so before you make any commitments, make sure that you have their input about what they would like from their new home. By doing so, you are showing them that you see them as an individual, and give them the respect they deserve.

Author bio: Laura-Jane Evans

Having trained as a care worker initially, Laura-Jane now works in the community to provide social events and talks for seniors from surrounding nursing homes. She believes that everyone has the right to good care.

Please also review AIHCP’s Case Management Certificate program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification.

Written by Veronica Turner

Medical billing is a vital cog in the healthcare machine, a process that exists at the intersection of healthcare services and financial practices. If you’re a case manager looking to master medical billing and coding, it’s crucial to acquaint yourself with its many facets and core steps.

From patient registration to debt collection, medical billing offers a unique blend of challenges and rewards. This guide will provide an overview of basic principles that drive medical billing, equipping case managers with essential knowledge to navigate this complex landscape.

10 Basics of Medical Billing for Case Managers

Navigating the world of medical billing can be daunting. To make things simpler, we’ve broken down the medical billing process steps into 10 easy-to-understand basics for case managers.

1. Patient Registration

Patient registration is one of the primary steps in the medical billing process. This phase involves obtaining key details about patients, including their personal information, insurance details, and medical history. Simple missteps here can lead to delayed payments or denied claims.

It’s crucial that you get an accurate and complete data set during registration, as this impacts subsequent stages of billing and claims processing. To avoid errors and confusion later on, confirm all details with the patient or their caregiver right at the beginning.

2. Insurance Verification

Insurance verification is another important step in the medical billing process as a case manager. It consists of confirming that the patient’s insurance is valid, determining the level of coverage, and understanding exactly what treatments or procedures the policy includes.

This task can be time-consuming and often requires contacting insurance companies directly, but it’s crucial to prevent misunderstandings about payment responsibilities. Ultimately, successful insurance verification ensures that healthcare providers are compensated.

3. Medical Coding

Medical coding plays a significant part in the medical billing process for case managers. Essentially, it involves translating patient records into standardized codes used throughout the healthcare industry. These codes, including ICD and CPT, represent diagnoses and services.

Accuracy is paramount in this step, as incorrect or incomplete coding can lead to claim denials or delays by insurance providers. Therefore, being fluent in medical coding not only streamlines billing procedures but also ensures appropriate and timely reimbursements.

4. Charge Entry

Charge entry involves assigning appropriate costs to the medical services that a patient has received. It’s critical to note for this stage that charges should match the services and procedures as per their specific codes from both treatment records and insurance policies.

Any mismatch could lead to claim denials, making it crucial to be meticulous during charge entry. After all, accurate charge entries form a crucial basis for creating spotless invoices, ensuring smooth cash flow, and maintaining a healthy financial state for healthcare providers.

5. Claim Submission

Once the charges are entered accurately against the appropriate medical codes, it’s time to submit these claims to insurance providers. This procedure needs to be done promptly and without errors, using designated software that most healthcare providers have in place.

It’s important that you follow the specific guidelines of each insurance company when submitting claims. Otherwise, there could be delays or rejections. Well-organized claim submissions minimize disputes and ensure faster payments, two key factors of effective case management.

6. Payment Posting

As a case manager, once a claim has been approved and paid by the insurance company, it’s your job to post these payments accurately against each patient’s account. This involves matching received amounts with claims submissions, marking each settled claim as ‘paid.’

It also includes identifying and recording any adjustments or discrepancies like underpayments or overpayments. Getting this step right is integral to maintaining accurate financial records for both healthcare providers and patients, ensuring smooth closures to individual patient episodes.

7. Rejection Management

Rejection management is an area where case managers need to show their problem-solving skills. Sometimes, despite your best efforts, insurance companies might reject a claim due to various reasons, such as errors in coding or documentation or even timeline issues.

The key here is not to panic but to meticulously assess the rejection reason and take corrective actions accordingly. Replacement or corrected claims should be submitted promptly following the insurance company’s guidelines. Proper management of rejections ensures low denial rates.

8. Patient Statement Generation

Patient statement generation is technically the final step in the medical billing process. As a case manager, once insurance payments have been posted, you’ll need to generate statements for patients detailing any outstanding (or possibly late) balances for which they are responsible.

These statements typically include services provided, amounts paid by their insurance, and any remaining balance due. Patients should clearly understand what they are being charged for. Providing comprehensive, easy-to-understand bill statements helps in timely collections.

9. Debt Collection

Debt collection is an inevitable aspect of the medical billing process when patients fail to clear their dues. It’s important to handle this delicate task with empathy while maintaining professionalism. You may have to escalate outstanding patient balances to collections agencies.

This step often requires understanding intricate regulations around debt collection practices, especially those stipulated by the Fair Debt Collection Practices Act (FDCPA). Balancing prompt recoveries with compassionate communication can avoid creating strain in your relationships.

10. Report Generation and Analysis

In the world of medical billing, case managers are often tasked with report generation and analysis. This involves creating comprehensive summaries of the billing activities, including sent claims, payments received, current receivables, and rejected claims, among other data points.

These reports give valuable insights into the financial health of a healthcare provider and can identify patterns or areas for improvement. They help drive strategic decision-making for better financial management and provide proof to the IRS in case of an audit or legal dispute.

In Conclusion…

As you navigate this field, remember that every challenge is an opportunity to refine your skills as a case manager. By embracing these principles, you’re contributing to streamlining operations, mitigating disputes, and helping patients better understand their financial responsibilities.

Keep exploring these facets of medical billing and enhancing your skills. Stay informed about updates in healthcare finance, as proficiency in medical billing requires constant adaptation!

Author Bio:

Veronica Turner is a health and lifestyle writer with over 10 years of experience. She creates compelling content on nutrition, fitness, mental health, and overall wellness.

Please also review AIHCP’s Case Management Certificate program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification.

Written by Veronica Turner

Navigating the dynamic landscape of healthcare requires a nuanced blend of clinical competence, adaptability, and a persistent focus on patient satisfaction.

As medical professionals, your role isn’t confined to just diagnosing ailments and prescribing treatments. You’re the guiding force leading patients through their healthcare journey, making it as seamless and comfortable as possible. This process is also called the patient journey.

This article provides numerous top tips designed to help you rise to these challenges.

By adopting these strategies, from enhancing tech-savviness and promoting self-management to adopting patient-centric approaches, you can revamp the patient experience in your practice.

But first, we have to examine how the patient journey impacts the patient experience.

What is the Patient Experience?

Patient experience refers to interactions that the patient encounters throughout the healthcare journey. This includes interactions with nurses, doctors, healthcare staff, and facilities.

When we look at multiple aspects of the patient experience, we can assess whether patients are receiving respective, responsive, and individual care based on their needs and values. There are many ways that healthcare professionals can monitor and assess the client’s experience.

One way they’re doing this is through the use of technology and automation. For example, similar to how a peer-to-peer employee recognition platform improves your employee’s experience, healthcare apps like Practo improve the patient through doctor feedback.

Why Does Patient Experience Matter?

Here are a few reasons why patient experience matters:

• Higher Patient Satisfaction: Patients who receive timely support and complete respect are more eager to follow plans from their doctors, thus increasing their satisfaction.
• Improves Health Outcomes: when patients engage with their care team, they feel more confident about the treatment approach. Their compliance leads to better outcomes.
• Increases Your Bottom Line: Happy patients are more likely to come back to your healthcare facility. Therefore, your bottom line will increase drastically.
• Boosts Your Online Reputation: According to the National Research Corporation, there’s a link between a great patient experience and an improved online reputation.

When the patient journey is seamless, patient experience and satisfaction increase. However, it’s important to note that patient experience and patient satisfaction aren’t the same thing.

Patient experience is measured by the insights gained from patients, whereas patient satisfaction demonstrates to what extent their needs are fulfilled. Improving both is important to improve the health and wellness of your patients, so don’t focus on one and not the other.

How to Revamp the Patient Journey

Now that you know how patient experience is impacted by the patient journey, we can start creating one that works for your facility. Here’s how to revamp the patient journey.

Remove the Barriers in the Patient Journey

Transforming a patient’s healthcare journey requires removing potential barriers. Make information about appointments, procedures, and care plans easily accessible and understandable. Optimize wait times and foster an environment where patients feel heard.

Ease out complex procedures and streamline administrative tasks with technology. Incorporate regular check-ins post-treatment to ensure a continuous link of communication and trust. Every barrier you remove is a step towards personalized, dignified, and empowering care.

Make Efforts to Provide a Personal Touch

In healthcare, the personal touch really matters. It’s beyond just knowing a patient’s medical history. It’s about understanding their desires, fears, and lifestyle. Utilize patient interactions as an opportunity to connect on a deeper level. Do this through active listening and empathy.

Small but meaningful gestures can make a significant difference. For example, you might try remembering specific personal details they share or expressing sincere concern for their wellbeing. A personalized approach shows that you see your patients as individuals first.

Use Patient Engagement Software and an EHR

These modern tools facilitate interactive communication with your patients, streamline administrative tasks, and ensure a smooth continuum of care. EHRs specifically play a vital role in improving patient outcomes by creating easily accessible and organized medical histories.

Meanwhile, engagement software can send out automated reminders for appointments or medication refills. Embracing these innovative technologies will not only enhance your practice’s efficiency but will also greatly improve your patient’s healthcare experiences.

Offer Online Appointment Booking

Providing an online booking option is a step forward in enhancing patient convenience. This feature enables patients to schedule their visits at their convenience without the hassle of long waiting times on the phone. It becomes very useful for non-urgent medical inquiries.

By integrating this option into your practice’s website or patient portal, you ensure ease of access and keep pace with the digital age’s expectations. It also optimizes your administrative tasks and increases overall efficiency and productivity within your healthcare practice.

Automate what Can be Automated

Automation is key to minimizing mundane tasks and maximizing efficiency in the healthcare sector. Various administrative tasks like registration, appointment scheduling and reminding, billing, and even prescription refills can benefit from automation.

Utilizing software for these processes saves time and greatly reduces the chance of errors. This increased efficiency allows medical professionals more time to focus on patient care. It’s about working smarter, not harder, and ultimately leading to a better patient experience.

Gather and Utilize Data Insights

In an era of data-driven decisions, harnessing the power of data can optimize your practice. Systematically collect, analyze, and interpret patient data to gain insights into their needs and behaviors. EHRs, patient surveys, or wearable tech provide a treasure trove of such data.

Leveraged effectively, these insights can guide tailored service delivery and preventive healthcare strategies, improving patient engagement and satisfaction overall. Incorporating this approach propels your practice towards evidence-based care that is personalized yet effective.

Have a Patient-Centric Culture

Imbibing a patient-centric culture within your practice is crucial for revamping the patient journey. This approach prioritizes the needs, expectations, and experiences of patients above everything else. It underscores empathy, active listening, communication, and shared decision-making.

By shifting from disease-focused to patient-focused care, you emphasize treating the person as a whole rather than just addressing their symptoms. This cultural shift positively affects your practice’s operations and clinician-patient relationships, leading to enhanced patient satisfaction.

In Conclusion…

Embracing these top tips in your medical practice marks the beginning of an enhanced patient journey. Each small step you take to focus on patient care can have profound effects. Start by identifying potential barriers, then systematically address them using tech advancements and empathetic approaches. Use every opportunity to connect with patients on a personal level.

Author Bio:

Veronica Turner is a health and lifestyle writer with over 10 years of experience. She creates compelling content on nutrition, fitness, mental health, and overall wellness.

Please also review AIHCP’s Case Management Certificate program and see if it meets your academic and professional goals.  These programs are online and independent study and open to qualified professionals seeking a four year certification.