Case Management

Healthcare Case Management Program Article on ER Costs

Posted on by Dominick Flarey

Emergency room visits can be necessary but also costly financially.  This article looks at the cost incurred by average Americans at the ER but also many of the issues Americans face against insurance companies who refuse to pay for the care

The article, As an Insurer Resists Paying for ‘Avoidable’ E.R. Visits, Patients and Doctors Push Back, by Reed Abelson, Margot Sanger-Katz and Julie Creswell, looks at some of these issues and also connects you to other resources to help understand the nature of the ER. It states

“Anthem denied thousands of claims last year under its “avoidable E.R. program,” according to a sample of emergency room bills analyzed by the American College of Emergency Physicians. The program, which Anthem has been rolling out in a handful of states in recent years, reviews claims based on the final diagnosis of patients.”

To read the entire article, please click here

Please also review our Healthcare Case Management Program.

Healthcare Case Management Certification Article on Healthcare and America

Posted on by Dominick Flarey

Good article for healthcare professionals and the latest problems with healthcare and our financial situation

The article, The real reason health care is bankrupting America, by Dr. Kenneth L. Davis states

“The United States spends far more on health care than any other nation on the globe: $10,348 per person, which amounts to nearly 18 percent of gross domestic product. That is eight percentage points above the average of the industrialized member nations of the Organization for Economic Co-Operation and Development.”

To read the entire article, please click here

Please also review our Healthcare Case Management Certification and see if it matches your academic and professional needs.

The program is online, self study and independent with courses that lead to a four year certification.  Nurses and other healthcare professionals may enter and begin to an exciting career as a certified Case Manager.

Case Management Certification Article on HCAHPS Scores

Posted on by Dominick Flarey

Secure Your Score: A Few Tips to Improve Your Practice’s HCAHPS Score

Something healthcare practitioners should give a lot of attention to is the HCAHPS. This acronym stands for Hospital Consumer Assessment of Healthcare Providers and Systems. This is a survey that is filled out by patients to indicate their satisfaction or lack thereof with the services rendered at a medical facility. You can think of HCAHPS as a performance review performed by actual patients.

Hcahps is required by CMS, the Centers for Medicare and Medicaid Services. It is used for all hospitals in the United States. It is performed over the phone after a patient is discharged. The results of these surveys become part of the public record and are used by the government to determine reimbursement for that facility. It’s extremely important to receive good scores on this survey. Below are a few tips you can use to improve your practice’s HCAHPS scores.

Make Your Team Cognizant of HCAHPS

Obtaining high scores on HCAHPS requires good communication among all the staff members of a medical facility. It must be communicated to nurses, doctors and other staff members that HCAHPS is a strong priority. They must be made aware of the scores that have been received. There should be an open dialogue on how to improve scores and ways different staff members can do their part to improve the patient experience. Consider having staff meetings about HCAHPS specifically especially if low scores are an issue.

Treat Patients with Respect and Courtesy

Low HCAHPS scores may be an indication that patients believe they are not being treated with the right amount of respect and courtesy by nurses, doctors and others that work in a medical facility. The first question on the survey in fact regards the courtesy shown to a patient by nurses. Lack of respect and courtesy as perceived by the patient can throw off the entire score.

Sometimes, there may be a difference in perceptions regarding an interaction between a healthcare professional and a patient. Just because the healthcare professional believes the interaction went well does not mean the patient feels the same way. In this case, some additional training may be required. The patient should be properly greeted, and the healthcare professional should maintain eye contact with that patient. Having a friendly demeanor and making small talk can also go a long way with helping to improve patient satisfaction.

Listen to Patients

Another important question on the HCAHPS survey regards whether or not a patient was listened to properly. Listening is an important part of the healthcare process. It is one of the ways healthcare professionals like nurses and doctors gather evidence to help make informed decisions regarding patient care. Patients may be experiencing specific symptoms that they find very worrying. If a healthcare professional does not properly listen to what patients have to say and instead interrupts or ignores them, this can be very distressing.

Communicate Clearly with Patients

Listening is only part of proper communication with patients. You also need to be able to explain medical conditions, care plans, tests, prescriptions, etc. In a way that the patient understands. Whether or not this communication was clear enough is also something that is scored on the HCAHPS. Try to avoid technical medical jargon and explain things in ways that individual patients can comprehend. Don’t be afraid to use tools to help educate patients either. A DVD with animations that demonstrate how a certain medical procedure is performed can be an effective teaching tool.

Overall, HCAHPS is important. If you don’t receive good scores, you have an issue that must be immediately addressed. Improving HCAHPS scores isn’t only important because it’s used as a measuring tool by CMS. If you want to be a good healthcare practitioner, patients should feel satisfied with the care they receive in your facility.

 

Please also review our Case Management Certification

Healthcare Case Management Article

Posted on by Dominick Flarey

Good article for those interested in Healthcare Case Management.

The article, Care Management for Children With Medical Complexity: Integration Is Essential, by Richard C. Antonelli, Renee M. Turchi state, 

“In the report “Effectiveness of a Comprehensive Case Management Service for Children with Medical Complexity,” Simon et al1 examine the impact of a care management intervention that is based in a pediatric academic medical center on quality and cost outcomes for children with medical complexity (CMC) and their families. Rigorously designed studies like this are important and timely because increased attention is being given to achieving the national strategic priority to improve outcomes for high-resource–using children and youth.”

To read the entire article, please click here

If you would like to learn more about Healthcare Case Management, then please review our certification program and see if it matches your academic and professional needs.

Healthcare Case Management Article on Single Payer System

Posted on by Dominick Flarey

Good article for those interested in Healthcare Case Management.

The article, Single-payer would drastically change health care in America. Here’s how it works, by Kim Soffen states,

“As Republican efforts to repeal and replace the Affordable Care Act continue in the background, some Democrats are starting to eye a new health policy goal: implementing a single-payer system. Sen. Bernie Sanders (I-Vt.) introduced a single-payer bill in mid-September with 16 Democratic co-sponsors — 16 more than he got when he introduced the bill two years earlier. But how is the health-care system funded now, and how would “single-payer” change that?”

To read the entire article, please click here

If you would like to learn more about Healthcare Case Management or would like to become certified in Healthcare Case Management then please review our program and see if it matches your academic and professional needs.

Case Management Training Article On What Tech are the Coding Professionals Using Today?

Posted on by Dominick Flarey

Healthcare will always be an important part of society and a great provider of jobs. Millions of people seek medical care in hospitals every year. In recent years, there have been several developments in the health care industry, especially when it comes to technology. Hospitals are updating their billing systems, and healthcare facilities are using data support systems to supplement all the other kind of work they do. There are also several new technologies that make life easier for nurses, technicians and doctors. Here is a look at some of the newest tech being used by healthcare coders today.

 

Electronic Health Records

A few decades ago, medical billing systems were unorganized and unregulated. Today, medical facilities rely on electronic healthcare records. EHR software has changed the medical billing process. It has also reduced billing errors and made moderating between hospitals and insurance companies easier than ever. According to Integrity Support, their systems are used by a variety of types of healthcare facilities and centers and are followed by positive reviews wherever they are.

 

Changes to the ICD-9

Medical professionals have to keep a record of common and uncommon illnesses. Medical coders process thousands of claims every month. In 2015, the ICD-9 increased from 13,000 to 68,000 codes. Illnesses and treatments are assigned an alphanumeric code. Health care professionals are learning how to maintain security and analyze EHR data. This uniformity is making it easier for most processes to be integrated more fully and across systems.

 

Interoperability Between Health Systems

Value based health care is a necessity for medical professionals. Interoperability is an important part of the health care industry. Specialists and general practitioners need to communicate throughout a patient’s treatment process. Medical referral companies are helping doctors communicate, and the companies will be a large part of the health care industry in the near future.

 

Remote Patient Monitoring

Remote patient monitoring programs can collect a large amount of medical data. The data is sent to hospitals and nursing facilities. Health care professionals study the medical information, and the data becomes part of an effective treatment plan. Monitoring programs improve access to medical care, and the programs are cost-effective.

 

Medical Tricorder

A medical tricorder was the winning gadget at a global technology competition. It is used to record and review technical information. The device can diagnose diseases and record a patient’s vitals. It can also summarize a patient’s health status and monitor ongoing health data.

 

Digestible Sensors

Digestible sensors give healthcare professionals important information about their patients. The sensors can help doctors protect the patient’s organs. Eventually, digestible sensors will replace physicals. The sensors rely on the patient’s energy. When the data is collected, the information can be sent to a computer or mobile phone.

 

Healthcare technology continues to improve all aspects of the healthcare industry. Hardware and software developers are always introducing new applications and innovations and the changes will benefit patients and healthcare professionals.

 

Eileen O’Shanassy is a freelance writer and blogger based out of Flagstaff, AZ. She writes on a variety of topics and loves to research and write. She enjoys baking, biking, and kayaking. Check out her Twitter @eileenoshanassy.

Please also review our case management training today

Healthcare Case Management Program Article on Risk Based Reimbursement

Posted on by Dominick Flarey

Good article for certified case managers or other healthcare professionals involved in health management executive positions

The article, Health systems see returns on risk-based reimbursement, by Alex Kacik states,

“In this year’s Modern Healthcare Hospital Systems Survey, only nine out of 60 respondents said they derived 10% or more of their net patient revenue in 2016 from risk-based contracts, which was largely in line with last year’s survey. Three-quarters of the respondents estimated that risk-based contracts generated 4% or less of their net patient revenue, but most indicated their share of risk-based contracts would slightly increase in 2017.”

To read the entire article, please click here

Please also review our Healthcare Case Management Program

Healthcare Case Management Article on Work Injuries and Healthcare Coverage

Posted on by Dominick Flarey

Injured on the Job? How Being Injured at Work can Impact Your Healthcare

Being injured on the job has the potential to seriously impact not only your physical health, but also your financial health and well-being. The good news is that state and federal workers’ compensation laws mean that there is a good chance your medical expenses will be covered. In addition, although approximately 75% of workers’ compensation cases only cover medical expenses, you may also be entitled to compensation for lost wages.

Unfortunately, while the workers’ compensation program provides many benefits to those injured on the job, it also has the potential to seriously affect the type and quality of the health care you receive. For this reason, it is essential that you know about the potential impacts to your health care in order to be fully prepared should you be unfortunate enough to experience a work-related injury.

Your Normal Health Insurance Won’t Cover Your Injury
Almost every health insurance policy contains an exclusion for work-related injuries, which means that your normal health insurance won’t cover any medical expenses related to treating injuries you suffered on the job. The reason behind this is that these expenses should instead be covered by your employer’s workers’ compensation insurance. However, your health insurance provider may still be required to pay for your medical expenses should the workers’ compensation insurance deny payment for whatever reason. Of course, it’s always a good idea to seek out workers’ comp lawyers in your area to ensure that your rights are respected.

You May Be Limited in Your Choice of Doctor
Not all doctors and hospitals accept workers’ compensation insurance, which means that you may be limited in your choice of doctors. If your current doctor does accept workers’ compensation insurance, you will still be able to use this doctor in most cases. However, should your doctor not accept workers’ comp, you will usually be forced to begin searching for medical professionals in your area that do take workers’ compensation cases.

You Could Be Forced to Wait for Treatment
Unfortunately, filing a workers’ compensation claim also means that you may be forced to wait longer before you can begin receiving any necessary treatments for your injury. The reason is that all medical expenses generally need to be approved by the workers’ compensation insurer before they can be performed. How this works is that first the doctor must determine whatever medical treatments are necessary to treat your injury. After this, the doctor then sends a request for authorization to the insurer, which then must determine that the treatment is necessary and reasonable before sending final approval back to the doctor. Although the process typically doesn’t take more than a few days, you will still have to wait to begin treatment until this final approval has been received.

American workers’ compensation laws were put in place in order to protect workers and ensure that their medical expenses are covered in case of a work-related injury. While this is definitely a huge benefit to anyone who would otherwise be unable to cover the costs of these medical expenses, it is still important that everyone is also aware of the ways in which a workers’ compensation claim can affect the health care you receive.

About the Author: Lizzie Weakley is a freelance writer from Columbus, Ohio. She went to college at The Ohio State University where she studied communications. In her free time, she enjoys the outdoors and long walks in the park with her 3-year-old husky Snowball.

Please also review our Healthcare Case Management Program

Case Management Certification Program Article on Small Practice Revenue Cycle

Posted on by Dominick Flarey

Good article for certified case managers.

The article, “3 Pain Points Affecting Small Practice Healthcare Revenue Cycle” by Jacqueline Belliveau states,

“While working in a small practice allows providers to really understand their patients and their community’s healthcare needs, it can also create unique healthcare revenue cycle management challenges.

Small practices come with several advantages. Some providers prefer the close relationship of working with just a couple other physicians versus a multitude of providers in a hospital.”

To read the entire article, please click here

Please also review our case management certification program to learn more.  Please review to see if it matches your academic and professional needs.

Healthcare Case Management Program Article on ER and Clinics

Posted on by Dominick Flarey

Good article regarding traditional ER’s and clinics.

The article, “The Lines Are Blurred Between Freestanding ERs and Urgent Care Centers”  by Olivia Nguyen states

“Last November in Frisco, Candie and Dustin Sandlin entered a Legacy ER & Urgent Care center—a walk-in clinic that also operates as a freestanding emergency center—because the couple’s primary-care physician was unavailable. Candie, experiencing symptoms of a migraine headache, was told by the on-site doctor that a CAT scan was needed to rule out any serious diagnoses.”

To read the entire article, please click here

If you are interested in Case Management and healthcare, then please review our healthcare case management program