Teamwork: Reduced Medicare FFS LOS by 0.88 day in one month

Teamwork goes a long way. I am very proud of the hospital in Southern CA  for the teamwork shown to reduce Medicare FFS length of stay (LOS) by 0.88 days in one month. We started Interim Work in last week of October 2018. Hospital had not much success to reduce LOS in this area for […]

2019 Medicare Inpatient Only List

2019 Inpatient only list We get several request for CMS Medicare Inpatient only list. Some, if not most, find it harder to find it using CMS website. Even after you find it, it is not posted in an easy   to use format. We have increased font size to make it easier to read, it has […]

CMS expects Hospitals to use IM letter and Detail Notice of Discharge by August 28, 2017

Hospitals and Critical Access Hospitals must use these notices no later than Monday, August 28. If you need OMB approval number for the forms, please feel free to contact me. The following updated notices have been approved by the Office of Management and Budget. * Important Message from Medicare • Detailed Notice of Discharge The […]

No Payment For A Non-emergent Use Of The Emergency Department (ED)

    Emergency Room utilization per 1,000 population has increased by 21% from 1999 to 2015 as per data published by The Henry J. Kaiser Family Foundation. The foundation has done a great job to show the utilization of ED by the ownership (the State/Local Government; Not-for-Profit or For-Profit) of the hospitals. You can review […]

The Secret To Consistently Successful Results In Case Management

Even after the successful orientation, training, and annual re-training programs in place, many of the leaders and the organizations are still struggling to get the favorable outcomes to achieve desired goals. Why is that? One of the reasons could be that they rely on a job description to tell their employees of the job expectation. […]

The Cost Of Medicare Inpatient Care And The Reimbursement Trends

      When we reviewed the national trends for the hospitals’ cost and reimbursement using MedPAR (Medicare Provider Analysis and Review) data from Federal Fiscal Year 2011 to 2015, it is clear that many hospitals suffered a financial loss in FY 2015 in this area. The cost per case for treating the inpatient level […]

ACA’s Impact On The Individuals Who Pay The Full cost of Insurance Premiums

The Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services released a report that shows the true impact of the Affordable Care Act on the health insurance premiums paid by the individual.   Comparing the average premiums found in 2013 MLR (Medical Loss Ratio) data and 2017 […]

Medicare 2016 Inpatient List Effective January 01-01-2016

Happy New Year. If you have not updated your Medicare Inpatient list by now then here is a file you may want to use to check Medicare Inpatient list effective Jan 1, 2016. You can refer to CMS website for detail explanation and information. CMS Medicare Inpatient list 1-1-2016

CMS 2-midnight update 10-30-2015

CMS has published the update to 2-midnight rules on October 30, 2015. It is a 3-page document. Federal Register update will be available on 11-3-2015 and use this link to find the document (1221 pages long)  We are able to find the documents online on CMS website as of 11-1-2015. It clarifies the information about QIO […]

A Substantial Reduction in Medicare CMI Adjusted LOS

I am very proud of the care coordination team (the case management team, the nursing, and the physicians) at this client site for reducing the  Medicare case mix adjusted length of stay in 3 months. We were asked to provide interim Coverage at this hospital in Southern California. The ministry had six different Directors of Case […]

The Federal Reserve Bank And The Hospital Case Management

  If you work in case management, it is not uncommon for you o feel the pressure from the hospital administration reduce the length of stay, reduce denials,  readmissions, improve  CMS compliance, patient throughput, increase case mix index, patient and physician satisfaction. If they could, the administration would ask you to print money to make […]

A proven simple Case Management Approach that Delivers Outstanding Results

 Are you frustrated with higher length of stay, denials, readmissions, late discharges in the evening or sluggish patient throughput and CMS compliance  issues (2-midnight, CMS Probe & educate results are 30% or more error rate)  or some combinations of the list of issues identified here?  Does your case management staff usually feels that hospital is […]

Who is watching over Utilization Review Committee?

Volkswagen AG  chose not to learn from the independent study completed by Daniel Carder, an engineer with a small team of five people.  Initially, the group questioned the findings, as it was hard for them to believe what they had discovered.  Volkswagen had known the audit results about 18 months before we learned the announcement […]