Designing and executing a clinical resource management program is not easy. It’s not so much that any one part of the program is difficult to design and implement. Rather, it’s the combination of all the parts that becomes untenable.
When we started this newsletter back in 1994, we reported the difficulties in obtaining information about payer denials. Hospitals simply could not provide actionable information to identify the source of their denials...
When case management was introduced in hospitals in the mid 80s, it was accompanied by a promise to control costs at the bedside.
In December, 2009, Connolly Healthcare, CMS' RAC for Region C announced its first targets for complex review with a list of 24 DRGs. A few weeks later it added 15 more DRGs to its list. For an up-to-date list of the latest CMS RAC approved items by state, use this link
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The January issue of CRM UPDATE features an article on the importance of objectively demonstrating hospital case management value. Read it now!

The Leader's Guide to Hospital Case Management
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Deonna Villegas-McPetersCommunity Regional Medical CenterFresno, CA