, Operations Manager/Case Management

The Medicare Administrative Contractors (MACs) have implemented pre-payment audits and denials for hospitals. Beginning in 2012, hospitals’ Medicare reimbursement is at risk pending an additional documentation review to determine medical necessity. For many hospitals, these developments represent considerable revenue losses. Such changes could trigger further evolution of case management practice; beyond the traditional role to one of pre-hospital medical necessity. This session will provide participants with a better understanding of pre-payment audits. Attendees will review specific denial avoidance strategies to contribute to the hospital’s performance improvement. The session will examine how the role of the case manager is changing as the healthcare landscape changes, and how the case manager can incorporate these changes into their daily practice.

Learning Objectives:
1. Discuss pre-payment audits’ impact on hospital reimbursement

2. Institute denial avoidance strategies

3. Develop a more comprehensive role of the case management department