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Is Your Case Management Practice Compliant: Here’s What You Need to Know
- Compliance overview for case managers
- Balancing quality and cost
- The Conditions of Participation
- Compliance at the access points
- The 2-Midnight Rule and Observation
- The NOTICE Act
- The Important Message from Medicare\
- The HINN
- Utilization management and compliance
- Documenting for compliance
- How to perform a compliance gap analysis
- Compliant UR Committee
- Changes in Patient Choice
Overview of the webinar
As case managers we must be aware of the myriad of compliance issues that we must adhere to in our daily practice. Never has this been more important to our work as case managers then it is now. Our ability to remain compliant has become an element of audits from accrediting bodies such as the Joint Commission as well as the Centers for Medicare and Medicaid Services (CMS). It is the right thing to do for patients as well.
This program will review the compliance issues that most greatly impact your practice such as the 2-midnight rule, the NOTICE Act, HINNs, The Important Message and others. The Joint Commission is now monitoring these issues when they have deemed status from Medicare, so your compliance is critical to a good Joint Commission survey outcome. This program will help you to identify where you may have compliance practice gaps as well as how to fix them!
Who should attend?
- Director of Case Management
- Compliance Officer
- RN Case Managers
- Director of Quality Management
- Director of Social Work
- Social Workers
- Hospitalists
- Physician Advisor
Why should you attend?
As a case manager you may not be up-to-date on all the compliance issues affecting case managers in the acute care setting. While some of them have been around for years, others are fairly new. Some are directly linked to reimbursement.
By attending this session you will be able to ensure that you understand the compliance issues directly related to the practice of case management and that you have incorporated them into your daily practice. Compliance includes documentation and communication with the patient and family as well. Be sure that your processes are hard-wired and part of your daily routine.
Faculty - Dr.Toni G. Cesta
Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department’s efficiency and effectiveness.
The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.
Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.
Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.
Dr. Cesta has presented topics on case management at national and international conferences and workshops. Her books include “Nursing Case Management: From Essentials to Advanced Practice Applications”, “The Case Manager’s Survival Guide: Winning Strategies in the New Healthcare Environment”, “The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice”, “Survival Strategies for Nurses in Managed Care” and “Core Skills for Hospital Case Managers”.