All Entries Tagged With: "LOS"

Denial Management – how strong is your process for concurrent denials?

We are evaluating our denial program only to assess that it was not as strong as we would like. As case management departments prepare for upcoming Recovery Audit Contractor (RAC), retro denials from health plans, and concurrent denials.
Our case management department looked at our process and it became clear that our management of our inpatients denials lacked process delineation. We began to re-assess this specific process as well as redefine our entire denial program.
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Audio update: Managing LOS

As pay for performance and Recovery Audit Contractor investigations gain a greater bearing on the amount and expediency of reimbursement, managing length of stay (LOS) has become even more crucial for case managers. While responsibilities of case managers expand, an important measure of success continues to be managing LOS.

Many case management departments look at meeting a target number of days a patient stays at a facility, however, evidence has shown this may not yield the best outcomes when looking to manage and improve LOS. Inova Health System in northern VA, has had immediate and sustained success in reducing LOS through targeting clinical milestones. Its focus has been on improvement of the patient’s condition and minimization of avoidable complications, resulting in improved quality of care and a proven reduction in LOS.
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CMS, RACs, POA, LOS–but what about the patient?

Boy is healthcare ever on a fast track and getting more complex and confusing. There are new and revised regulations coming from the Centers of Medicare and Medicaid Services (CMS), and the Recovery Audit Contractor (RAC) implementation has us going to more meetings than we know what to do with. Let’s not forget about Present on Admission (POA) and we need to be monitoring those lengths of stay (LOS). Don’t get me wrong, these are all very important, high priority issues, but what about the patient?
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