This webinar will focus on regulatory requirements, optimal processes and define the difference in collaboration with both internal and external physician advisor roles. It will also discuss the role of the physician advisor and staffing needs to implement this important role.
Consultant, Case Management Concepts LLC
Bev Cunningham is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.
She has written a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.
The role of the physician advisor in hospital case management is a varied role. Not every hospital has an internal physician advisor. If a hospital does not have an internal physician advisor, it usually has an external physician advisor. Rarely are physicians prepared to this role. Additionally, rarely are case managers or case management leaders prepared for implementing and/or collaborating with physicians in this role. With value-based reimbursement, the collaborative role of the physician advisor will be one of the lynchpins to assist the case management department and practicing physicians to positively impact hospital outcomes.
The CMS Conditions of Participation and the 2 midnight rule require intervention with physicians in the utilization review section of the conditions and auditing for compliance to the 2 midnight rule. Most hospitals do not follow the requirements of this important aspect of case management compliance. Furthermore, there is rarely auditing of the role of the physician advisor and most hospitals do not educate their staff for meaningful collaboration and use of the role.
As health care organizations and physicians endeavor to provide compliance to the Conditions of Participation and improve outcomes identified in the case management dashboard, the challenges mentioned above continue, leaving the hospital at risk for not complying with these requirements.
Registrants may cancel up to two working days prior to the course start date and will receive a letter of credit to be used towards a future course up to one year from date of issuance. FDATrainingAlert would process/provide refund if the Live Webinar has been cancelled. The attendee could choose between the recorded version of the webinar or refund for any cancelled webinar. Refunds will not be given to participants who do not show up for the webinar. On-Demand Recordings can be requested in exchange.
Webinar may be cancelled due to lack of enrolment or unavoidable factors. Registrants will be notified 24hours in advance if a cancellation occurs. Substitutions can happen any time.
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