Basics of Case Management: Five-Part Virtual Series

Details

Each session will take place from 9 to 11 a.m.

• Tuesday, Oct. 1 — Part 1
• Tuesday, Oct. 8 — Part 2
• Tuesday, Oct. 15 — Part 3
• Tuesday, Oct. 22 — Part 4
• Tuesday, Oct. 29 — Part 5

Audience

chief medical officers, chief nursing officers, case managers, compliance officers, emergency department personnel, Joint Commission coordinators, medical records staff, quality improvement personnel and risk managers

The following program content was provided by the speaker.

Overview

Due to a rapidly changing environment, it can be challenging to stay knowledgeable about the issues that affect your role as a case manager. Reimbursement has changed dramatically as has utilization management, transitional planning and length of stay management. CMS incorporated changes that impact payments related to readmissions, length of stay and cost of care.

This series will provide the core knowledge needed to enhance skills and understand the foundational work of case management.

• Part 1 will discuss fundamental issues, including reimbursement systems, the history of case management, common trends and an introduction to community case management.
• Part 2 will discuss the role of utilization management, including rules, regulations and strategies for incorporating utilization into your daily routine.
• Part 3 will provide insights and up-to-date information on the role of discharge planning, including new rules instituted in 2020.
• Part 4 will provide an in-depth review of care coordination.
• Part 5 will feature how to integrate the roles and functions reviewed in previous sessions. There also will be a comparison of two state-of-the-art case management models. Attendees will learn about the complementary but separate roles of RN case managers and social work case managers.

Whether you are new to case management or a seasoned pro, this series will provide the latest information to produce the best outcomes for you, your patients and your organization.

Objectives

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

Part 1:

• understand the history of case management
• recall reimbursement structures and their application to case management
• explain how case management fits into today’s health care system
• discuss the ways in which case management is a strategy for managing cost and quality under the latest CMS reimbursement models

Part 2:

• describe the differences between utilization review and utilization management
• discuss the best strategies for managing utilization reviews and other issues related to utilization management
• identify ways in which a strong utilization management process can reduce payment denials

Part 3:

• describe discharge planning as a process, not an outcome
• discuss the new CMS changes related to transitional and discharge planning, and how they can impact your practice
• identify best practice strategies for transitioning patients across the continuum of care

Part 4:

• recite the key elements of effective care coordination
• discuss ways to incorporate care coordination into your daily workflow
• identify how care coordination can be derailed and how to keep it on track

Part 5:

• describe the different skill sets and roles of RN case managers and social work case managers
• discuss specialty case management roles, and determine new or updated roles for your contemporary case management department
• explain the evolution of case management models
• identify the best model to ensure a contemporary case management department