WEBINAR: Case Management Boot Camp, Part I of III
Case Management (CM) Boot Camp, Part I of III: A Primer on CM and Acute Care Reimbursement – From DRGs to Bundled Payments
Course Curriculum
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 discussed in the context of how hospitals are reimbursed. This will be followed by a discussion on managed care and managed care contracting as well as the various managed care products currently on the market.
Our speaker include 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. In this environment, patients may access care and use resources at any touch point on the continuum. A review of the state of the art in case management from both the acute care and community sides will be discussed as well as the emerging trends that correlate directly with changes in health care reimbursement over time.
Learning Objectives
At the conclusion of this session, the participants will be able to:
1. Discuss how hospital stays are reimbursed under the DRGs and prospective payment.
2. Describe managed care, the different products and what case management's role is.
3. Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).
4. Identify the changing roles of case management professionals across the continuum of care.
Target Audience
Anyone involved with transitions in care including RN case managers, Nursing directors, social workers, case management personnel, social work staff, post-acute care providers, home care personnel, physician advisors and other interested personnel.
Faculty
Toni G. Cesta, Ph.D., RN, FAAN is a founding partner of Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating case management models in the acute care, emergency department and outpatient settings. Dr. Cesta writes a monthly column called "Case Management Insider" in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management.