All Entries Tagged With: "director of case management"
2009 Case Management Monthly salary survey
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We at HCPro want to provide you with the salary information for case managers that you need in the most useful format.
Please help us better understand your position by completing the 2009 Case Management Monthly Salary Survey. The survey results will be included in an upcoming issue of Case Management Monthly.
The link below will take you to the survey’s Web site; simply click on the link to answer the survey questions online. If the click-through does not work, please cut and paste the URL into the address bar of your browser. Here’s the link to the survey:
http://www.zoomerang.com/Survey/?p=WEB229QJRN9FKN
Thank you for your time and assistance.
The ZPICs have begun in zone 4
Health Integrity LLC, the zone four (Colorado, New Mexico, Oklahoma, and Texas) Zone Program Integrity Contractor (ZPIC), has begun requesting medical records for review.
The ZPICs are Medicare audit contractors that specifically identify cases of fraud and abuse. According to the CMS Program Integrity Manual, ZPICs may “take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid out and that any mistaken payments are recouped.”
During HCPro’s November 3 audio conference, “Zone Program Integrity Contractors Learn Who They Are, What They Want, and How to Respond to a Review”, a caller from Oklahoma shared that a Health Integrity representative visited the facility recently and stayed for a two-day, on-site audit. During the visit, the auditor reviewed more than 40 medical records related to one-day stays dating back as far as 2007.
This information came as a mild surprise to Robert Wade, partner at Baker and Daniels, LLP, in South Bend, IN. Wade said ZPICs have the authority to start reviews as soon as they are awarded the contract, and Health Integrity was awarded the zone four contract in February.
Facilities should be aware that ZPICs could notify the facility via fax a mere hour before the visit. This can leave little time for the facility to prepare. Wade said in situations where ZPICs give short notice, facilities are within their rights to supplement any requested records with supporting documentation even after the visit is complete.
So far CMS has awarded only three of the seven ZPIC contracts:
- Zone 4: Colorado, New Mexico, Oklahoma, and Texas—Health Integrity LLC
- Zone 5: Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia—Advance Med
- Zone 7: Florida, Puerto Rico, and Virgin Islands—SafeGuard Services LLC
So what does this information mean for providers that are within one of these zones?
“They can come knocking at any time,” Wade said.
Consequences of a ZPIC review include payment denials, recoupment of overpayments, and referral to other law enforcement agencies. Because ZPICs can refer cases to the Department of Justice, Office of Inspector General, or other law enforcement agencies, a ZPIC review may only be the first step in a long legal battle.
Have you heard about the ZPICs starting in any other zones?
Case Management Week is almost upon us
Case managers, next week is all about you. October 11-17, is National Case Management Week, which is your opportunity to spread awareness about what case managers do and how they improve healthcare across the continuum of care.
Several case management associations have released information that describes how you and your staff members can celebrate all things case management.
If you are looking for National Case Management Week posters, banners, and pins check out the American Case Management Association’s National Case Management Week catalog.
The Case Management Society of America (CMSA) put out a 20-page packet that is full of ways you can raise case management awareness:
- Individual activities
- Tell 10 other professionals you are a case manager.
- Offer to speak at community events on case management.
- Write letters to your local paper. Contact radio and TV stations to let them know about CM Week.
- Write a guest editorial to newspapers, journals or magazines regarding the positive impact of case management.
- Distribute a press release announcing National CM Week.
- Community activities
- Host a celebration or reception to recognize a case manager in your community.
- Host professional seminars and workshops for health professionals in your community.
- Arrange exhibits and displays in public facilities.
This is not an exhaustive list. See the full list of suggestions at the CMSA Web site
Please share your plans for National Case Management Week.
One bad run-in shouldn’t define entire field of case management
Editor’s Note: I came across this letter to the editor that Nancy Sullivan, Director Case Management Massachusetts General Hospital Boston, submitted to the Boston Globe in response to an op-ed column that spoke negatively about case managers. I would like to thank Nancy Sullivan for allowing her letter to also appear on the Case Management Mentor blog.
In her op-ed “The ‘quicker and sicker’ exit strategy’’ (July 30) Deborah Schuss describes her family’s negative – and indeed, unacceptable – encounter with a case manager. One patient’s bad experience, however, should not define an entire field.
As trained and experienced nurses, social workers, and other health professionals, case managers work diligently and compassionately to ensure a safe transition for patients from the hospital to the next setting of care or home. Case managers serve as trusted guides during a period of uncertainty and change, helping families sort out details of ongoing care, and arranging for services after discharge.
As essential members of the patient care team, case managers advocate for the patient and family as they collaborate with physicians, nurses, and others. And while case managers help ensure that care is delivered in a timely and cost-effective manner, their decisions are driven by what is in the patient’s best interest.
I am privileged to witness each day the impact of case managers. One grateful patient wrote that his case manager “went out of her way to do detailed planning about my discharge, checked in with me regularly, was patient with all the questions I had, and reached out to my wife in addition to myself.’’ A family member expressed deep appreciation to a case manager who had spent extraordinary time arranging medical care in Florida so that a terminally ill young mother could travel to Walt Disney World with her children.
These are the case managers I know – true representatives of a profession I am proud to be part of.
Nancy Sullivan
Director Case management Massachusetts General Hospital Boston
Time-saving strategies for hospital case managers!
The job of a hospital case manager is complex, to say the least. Between keeping up with regulatory changes, ensuring proper clinical documentation, planning for appropriate discharge, and making sure patients receive adequate care while your facility maintains fiscal integrity, it can be difficult to juggle all that needs to be done.
In an upcoming issue of Case Management Monthly, we’d like to feature the top ten time-saving tips for hospital case managers from you, our readers. Help your fellow hospital case management professionals beat the stress of their job and optimize their time by sharing your best time-saving strategies. Send your tips to Managing Editor Janelle Randazza; all selected entrants will be featured in the June 2009 issue of Case Management Monthly and will receive a free copy of the issue.
CMW Tip of the Week: Data collection dos and don’ts
This week’s tip, an “Ask the Expert,” comes from Karen Zander, RN, MS, CMAC, FAAN.
Q: The social workers and case managers are spending too much time collecting data, and they don’t care about the data I show them. What should I, the director, do?
A: Do an inventory using a chart of the data they are collecting every day, which category of personnel collects it, how the data gets processed into reports, and who wants the reports—which may be more than one person or group. Then determine how important it is and to whom, which may take some conversations. Be willing to drop some element of the data collection if 1) it is not interdependent on another piece of information (an interdependency might be avoidable days as a partial explanation of LOS) and if 2) the data has no bearing on current decisions by you or the executive team (such as productivity measures that do not help you get more needed FTEs). And a huge consideration is that every piece of data costs money to collect and process and display and review!
Have a tip or tool you’d like to share? Or maybe a question for our experts? E-mail it to editor Julie McGinley at jmcginley@hcpro.com.Your thoughts could be featured in the next issue of Case Management Weekly!
