Part Two: Beyond Basics of Case Management Five-Part Series (ODW5012PT)-2025 Beyond Basics Case Mgt Part 2 Presentation

2025 Beyond Basics Case Mgt Part 2 Presentation

Pdf Summary

The document outlines a comprehensive approach to case management in healthcare, focusing on the Emergency Department (ED) and inpatient settings, particularly around the 2-Midnight Rule and utilization management. The 2-Midnight Rule centers on physician expectations for patient stays in hospitals, ensuring admissions are medically justified, expected to exceed two midnights for inpatient status, and adequately documented to align with Centers for Medicare and Medicaid Services (CMS) guidelines.<br /><br />Key activities within the ED case management include assigning appropriate levels of care early, managing observation patients, ensuring compliance with medical necessity, and aiming to reduce unnecessary admissions and readmissions. An emphasis is placed on physician documentation to support inpatient admissions and manage exceptions, including unforeseen circumstances and short stays that may not meet the 2-Midnight requirement but are justified due to medical urgency.<br /><br />The document highlights various entry points in hospital settings and underscores the need for case managers to oversee all access points, ensuring smooth transitions for patients needing observation care versus inpatient treatment. Utilization Management involves real-time assessments to verify medical necessity and appropriateness from admission through discharge.<br /><br />It underscores the roles of case managers and social workers in addressing both medical and psychosocial aspects of patient care, demonstrating how close coordination among healthcare providers can influence patient outcomes, optimize lengths of stay, and manage healthcare costs. The document ultimately promotes the significance of structured case management processes to align with regulatory standards and enhance patient and physician satisfaction.

Keywords

case management

Emergency Department

2-Midnight Rule

utilization management

physician documentation

medical necessity

patient outcomes

inpatient admissions

healthcare costs

CMS guidelines