Description

Case managers and social workers need to maintain compliance in several areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments for compliance with the Conditions of Participation as well as other regulatory requirements. Every case management professional needs to know how these requirements impact their professional practice.

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!

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 than 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.

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.

Learning Objectives:-

• Understand the compliance issues required under the Conditions of Participation for Utilization Management and Discharge Planning.
• Describe your responsibilities as they relate to Observation and the 2-Midnight Rule.
• Review your requirements to be compliant with the Important Message from Medicare.
• Explain how the patient choice lists are used.
• Understand the different types of things and when they should be given.
• Learn how to document compliance.
• Understand the important role of social work and RN case managers in maintaining their professional compliance.

Areas Covered:-

• Definition of compliance
• Definition of fraud
• Agencies requiring compliance
• Hospital processes and penalties
• Case management processes related to billing
• Ensuring payment
• Medical necessity and billing rules
• Conditions of Participation for Utilization Review and Discharge Planning
• Condition Code 44
• Provider Liable billing
• The 2 Midnight Rule
• Observation Status
• Hospital Issues Notices of Non-Coverage by Type
• Observation Status
• Patient choice
• 3 Day Qualifying Stay
• NOTICE Act

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