Let's look at one specific area where case managers can make a difference: reducing hospital-acquired anemia (HAA). This condition is often the result of blood draws performed cumulatively—and sometimes excessively—as part of laboratory testing.The prevalence of HAA can be exacerbated by another form of inappropriate medical care—in this case, laboratory tests. The goal is to ensure a patient only undergoes laboratory tests he or she truly needs.
Regulatory compliance reforms have forced CMS to set the bar high for meeting evaluation and management (E/M) standards. This is especially true for clinical documentation improvement (CDI) performance for coding and billing level four and five patient visits in outpatient settings.
HIPAA isn’t the only privacy, security, and breach notification law in the country. In fact, HIPAA is designed to work with state laws, and in cases where state laws are stricter or prescribe a higher level of privacy or security, HIPAA explicitly directs covered entities and business associates to follow state law. A covered entity or business associate that isn’t in compliance with state privacy, security, and breach notification laws is not in compliance with HIPAA, and is at risk of both federal and state action.
This week’s Medicare updates include the April 2017 Medicare Quarterly Provider Compliance Newsletter, scribe services signature requirements, outlier limitation on OPPS Community Mental Health Centers Services, and more!
Case managers may not be physicians, but they are still integral to the quality of patient care. Regardless of whether a case manager’s role includes clinical or medical case management, utilization review, discharge planning, or a combination of these and more, if the case manager can advocate for the patient during the medical encounter, he or she can influence good clinical care, says Jackie Birmingham, RN, MS, clinical leadership at naviHealth: A Cardinal Health Company, headquartered in Brentwood, Tennessee, and author of Discharge Planning Guide: Tools for Compliance, Fourth Edition.
