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In the past, providers often dismissed trauma-induced outbursts as bad behavior or a character flaw.

Today, the complexity of patient care, increasing patient volumes and the need for streamlined care transitions require a revised approach.

Medicare short-stay review errors often occur because the staff responsible for the process aren’t given clear guidance.

Despite multiple lawsuits and threatened actions by private, state, and federal agencies across the country, UHG has been a longtime dominant force related to revenue cycle, provider staffing, utilization, and managed and commercial health insurance plans.

Despite the gains that many hospitals felt regarding MA final rule 4201, this appears to be an interesting clarification regarding the difference between the two-midnight presumption verse the two-midnight benchmark.

The rationale for these changes has not been elaborated on, but the move is expected to stir debate, particularly given that several of the suspended activities focus on health equity, social determinants of health (SDoH), and pandemic-related responses.

This marks a critical shift in the landscape for hospitals and case management teams, especially as they grapple with increasingly aggressive denial practices from MA plans for continued stay hospitalizations – particularly for those untimely authorizations and post-acute denials.

TEAM will run through December 31, 2030, and will test whether an episode-based payment approach tied to quality metrics can reduce Medicare expenditures while maintaining or improving care quality for beneficiaries.

Every day, scores of patients across the country enter inpatient hospital beds for what amounts to custodial care. 

There is a clear emerging tension between how hospital performance is measured under the HRRP in the proposed ruling and how MA plans are rated under the Medicare Star Ratings system.

The elimination of these measures marks a notable retreat from the CMS prior emphasis on collecting actionable data to address health disparities and improve care planning based on non-medical risk factors.

Hospitals that have successfully implemented a pull system employ dedicated discharge teams that proactively seek out patients eligible for discharge, ensuring a steady flow of patients to the lounge.

ED case managers can serve as gatekeepers for this high-traffic entry point, ensuring accurate status determinations, preventing unnecessary readmissions, and helping to keep as many inpatient beds open as possible.

Not surprisingly, the study found significant variability in how EDs screen for and document SDoH factors.

These kinds of delays should be a focus of your utilization management team’s assessment of avoidable days.

CMS reported that these changes will result in taxpayer savings of nearly $750 million; however, the math seems a little unclear.

By comparing observed infant mortality rates post-ban with expected rates, based on historical trends, the researchers assessed the impact of these restrictive policies on neonatal and infant health outcomes.

Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered.

Social workers play a crucial role in ensuring that patients receive not only medical treatment, but also psychosocial support, and that our healthcare providers receive clarity regarding social barriers our patients face.

By analyzing data from 13 million births of Black and white women aged 10–44, researchers found that even in less vulnerable areas, Black women remained at higher risk of maternal mortality than white women residing in more vulnerable locations.

According to this guidance, sex is defined as an immutable biological characteristic, categorizing individuals strictly as male or female.

Just as multi-level connections to hospital operations became tied to documentation, the same happened with placement of clinician orders. 

The executive order’s broad and sweeping language has led to confusion among federal agencies, contractors, and communities as they work to interpret and implement the directive.

This concerning trend suggests that external influences such as diet, pollution, and reproductive choices may be key contributors to the spike in cases (NBC News, Advisory).