Beyond Basics of Case Management Boot Camp, Part 2-2024 Beyond Basics Case Mgt Part 2 Presentation

2024 Beyond Basics Case Mgt Part 2 Presentation

Pdf Summary

This document discusses the importance of case management in healthcare settings, focusing on gatekeeping access points and the 2-midnight rule. It emphasizes the need for appropriate level of care assignment, reduction in readmissions, and compliance with medical necessity. The 2-midnight rule dictates that a patient's stay in the hospital must last at least two midnights for reimbursement. It also outlines exceptions to this rule and the role of physician certification in determining inpatient services' appropriateness. Utilization management starts at all access points to the facility, ensuring compliant and correct physician documentation.<br /><br />The role of case managers in managing observation patients and prioritizing observation cases is highlighted. It also discusses the changing landscape of the healthcare system, including the increase in emergency department visits and the importance of ED case management in facilitating patient flow. The document stresses the need for gatekeeping functions, facilitating care transitions, and integrating services between case management and social work for comprehensive patient care. Additionally, it covers the importance of reducing admission denials, readmissions, and in-patient length of stay, while enhancing patient and physician satisfaction.<br /><br />Overall, the document serves as a guide to case managers on effectively managing patient care, ensuring appropriate utilization of services, and supporting patient needs across various healthcare settings.

Keywords

Case management

Healthcare settings

Gatekeeping access points

2-midnight rule

Level of care assignment

Reductions in readmissions

Medical necessity compliance

Utilization management

Observation patients

Emergency department case management