WEBINAR: Case Management Boot Camp, Part III of III
Case Management (CM) Boot Camp, Part III of III: Fundamentals in Utilization Management and Discharge Planning
Course Curriculum
In this jam-packed program participants will learn how to stream-line your utilization management process as well as understand the Conditions of Participation for Utilization Review and how they impact on your work as a case manager. We will discuss the differences between utilization review and utilization management. The process for incorporating medical necessity into the process of utilization management will be explained, as well as a review of compliance components for utilization review and incorporation of Condition Code 44 into the two-midnight rule. Other focus areas that will be discuss will include the various types of Hospital-Issued Notices of Non-Coverage (HINNs) and discharge planning as a fundamental role of case managers and social workers.
Learning Objectives
At the conclusion of this session, the participants will be able to:
1. Discuss how medical necessity is applied during a clinical review.
2. Implement the correct processes for Condition Code 44 and Provider Liable billing.
3. Discuss the different types of hospital Issued Notices of Non-Coverage (HINN) and when to use each type.
4. Explain how to apply utilization review to the two-midnight rule process.
5. Describe how compliance applies to the utilization management process.
6. Implement the basics of discharge planning to their role as a case manager or social worker.
7. Describe the strategies to be used for best practice discharge planning.
Target Audience
Anyone involved with transitions in care including RN case managers, case management personnel, social work staff, post-acute care providers, physician advisors, finance directors, quality management 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.