Best Practices in Case Management 2021 : Module 1

Recorded Webinar | Beverly Cunningham and Toni G Cesta | From: Feb 16, 2021 - To: Dec 31, 2021

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Best Practices in Case Management 2021: Module 1 - The State of the Art in Case Management 2020 and Beyond

This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. Included in this will be a review of the DRG relative weights, case mix index, and expected lengths of stay. Medical record coding will be explained in the context of how hospitals get reimbursed. This will be followed by a discussion of managed care and managed care contracting as well as the various managed care products currently on the market. Also included will be a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touchpoint on the continuum.

A review of the state of the art in case management from both the acute care and community sides will also be discussed as well as the emerging trends that correlate directly with changes in health care reimbursement over time.

Session Outline:-

  • Diagnosis-related groups (DRG)
  • Medicare
  • Medicaid      
  • Managed care definition
  • Managed care contracting
  • Case rate, per diem, and % of charges contracts
  • Managed care products
  • Bundled payments – Mandatory and voluntary
  • The managing cost across the continuum
  • The history of case management
  • The merging roles of the RN case manager and social worker across the continuum of care
  • Acute care case management
  • Community-based case management

Learning Objectives:-

  • Understand how hospital stays are reimbursed under the DRGs and prospective payment.
  • Review managed care, the different products, and what case management’s role is.
  • Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).
  • Understand the changing roles of case management professionals across the continuum of care.

Why Should You Attend?

As case management professionals, we work with patients who may fall into one or more of the many combinations of healthcare reimbursement in play today, from government payers such as Medicare and Medicaid to managed care and bundled payments. Among our roles is included the responsibility of controlling cost and length of stay. Therefore we must be up-to-date on each and every payment scheme we may come in contact with.  In addition, we are advocates for our patients and families and we must be able to teach and explain to them how the various payment sources will impact them as well. Healthcare reimbursement knowledge is critical to your success as a case management professional.

This webinar will bring you up to speed on what you need to know to be successful in your role as an RN Case Manager or Social Worker. Also included will be the changing landscape of the roles of the social worker and case manager across the continuum of care.

Who Should Attend?

  • RN Case Managers
  • Social Workers
  • Directors of Case Management
  • Directors of Social Work
  • Post-Acute Care Providers
  • Home Care
  • Physician Advisors
  • Directors of Finance
  • Hospitalists
  • Directors of Nursing

Beverly Cunningham and Toni G Cesta

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, new documentation systems, and other strategies for improving care and reducing cost. The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.

Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.

Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

Dr. Cesta has been active in the research and development of case management for over 25 years. Her research in case management has included two funded studies measuring the effects of a case management model on congestive heart failure and fractured hip patient populations, with measures of patient satisfaction, quality of life, and short and long term clinical perceptions and outcomes.

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, the utilization management process, patient flow, and the role of the Case Manager and Social Worker in the Case Management process. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board.

She also co-authored the book Core Skills for Hospital Case Managers and wrote a chapter in most recent two editions of CMSA’s Core Curriculum for Case Management. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital, where she had responsibility for Case Management, Social Work, Health Information Management, Patient Access and Sold Organ Transplant services.