Case Management Boot Camp: A Primer on Case Management and Acute Care Reimbursement — From DRGs to Bundled Payments — Part I of III

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Start Time:12:00 AM
End Time:12:00 AM
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Additional Information

Provided by MHA Health Institute
Health Institute

Date & Time

Tuesday, Jan. 29
9:30 - 11:30 a.m.

Register on or before Monday, Jan. 21, to ensure delivery of instructional materials.

MHA members — $225
Nonmembers — $275

The webinar registration fee is for one phone line connection. Each additional phone line connection will be charged a registration fee. Get more value by inviting colleagues to join you on the one connection.

This webinar is being offered at a reduced registration fee to MHA-member hospitals thanks to a generous contribution from the MHA Management Services Corporation.


Anyone involved with transitions in care, including nurses, case managers, nursing directors, social workers, case management personnel, social work staff, post-acute care providers, home care personnel, physician advisors and other interested personnel.

The following program content was provided by the speaker.


This webinar will provide a foundation of knowledge and understanding of the diagnosis-related group system used as the structure for reimbursement under the Medicare and Medicaid programs. Participants will review the DRG relative weights, case mix index and expected lengths of stay. Medical record coding will be discussed in the context of how hospitals are reimbursed. This will be followed by a discussion on managed care and managed care contracting, as well as the various managed care products currently on the market.

The speaker will discuss on bundled payments and what case management professionals need to know to assist their organizations in controlling cost and length of stay in a bundled payment environment. In this environment, patients may access care and use resources at any touch point on the continuum. A review of the state of the art in case management from both the acute care and community sides will be discussed, as well as the emerging trends that correlate directly with changes in health care reimbursement over time.


At the conclusion of this session, participants will be able to:

  • discuss how hospital stays are reimbursed under the DRGs and prospective payment system
  • describe managed care, the different products and the role of case management
  • discuss bundled payments and other new payment models under the Centers for Medicare & Medicaid Services
  • identify the changing roles of case management professionals across the continuum of care


Toni G. Cesta, Ph.D., R.N., FAAN
Founding Partner
Case Management Concept, LLC

Toni G. Cesta, Ph.D., R.N., FAAN is a founding partner of Case Management Concepts, LLC, a consulting company that assists institutions in designing, implementing and evaluating case management models in the acute care, emergency department and outpatient settings. Dr. Cesta writes a monthly column called "Case Management Insider" in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management.