Description

Case management is a complex process involving the assessment, planning, facilitation, care coordination, evaluation and application of services to meet patients’ needs. As such it becomes a vital part of the healthcare system. Case managers need to comply with HIPAA, and it is difficult for them to comply with HIPAA due to their varied nature of duties.

Compliance is essential in healthcare to provide better services and facilities to patients. For a patient’s care, physicians, RN case managers as well as social workers collaborate to deliver the best of services. RN case managers have a vital role in assessing the needs, managing resources and services, and providing services and support to patients. If they comply with HIPAA, the working of the healthcare organization becomes smooth.

Specific regulations, tools, and technology are required by RN case managers to carry out their work and to comply with HIPAA. This session will highlight the compliance issues faced by every case manager and the tools required by them, especially the Two-Midnight rule, the NOTICE Act, HINNs, the Important Message, etc.

The Joint Commission is an independent non-profit body that certifies healthcare organizations. It works to improve the safety and quality standards of healthcare continuously and is now monitoring these compliance issues. So, your compliance is essential to a good Joint Commission Survey outcome. The online conference will help you to identify the compliance gaps in your practice and how you can fix them.

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.
• Your requirements to be compliant with the Important Message from Medicare.
• Explain how the patient choice lists are used.
• Understand the different types of HINNs and when they should be given. 
• Document for compliance.

Course Outline:-

• Compliance Measures for RN and SW
• Who Requires Compliance
• Compliance Goals of Access point CM
• Observation Status and Compliance
• Notice Act
• The 2 Midnight Rule
• Conditions of Participation
• Provide Liable – Part B Billing
• The Patient’s Right to Appeal
• Patient Choice
• HINNs
• Role of the Leader in CM Compliance

Why Should You Attend?

The Joint Commission and the Center for Medicare and Medicaid Services (CMS) are responsible for auditing hospitals and case management units for compliance with the Conditions of Participation and other regulations. Case managers need to be aware of and comply with these regulations for their smooth working.

Compliance also includes coding and documentation of services, as well as communication with the patients’ family members. Case managers and social workers need to comply in several areas, especially utilization management and discharge planning. This session can help you acknowledge the compliance issues directly related to your case management practices. It can also help you ensure that you take adequate measures to rectify them and incorporate in your daily routine.

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