Compliance Measures for Case Management Professionals in the Acute Care Setting

This program will review the compliance issues that most greatly impact your practice as a case management professional such as the 2-midnight rule, the NOTICE Act, HINNs, The Important Message, and others. Do you have a utilization review committee and is it compliant with the Conditions of Participation for Utilization Review?  Are you compliant with the Federal rules for discharge planning? Case management in acute care centers has a variety of required areas of compliance. The Joint Commission is now monitoring these issues when they have deemed status from Medicare, so your compliance is critical to a good Joint Commission survey outcome.  This program will help you to identify where you may have compliance practice gaps as well as how to fix them!

• Compliance overview for case managers
• Balancing quality and cost
• The Conditions of Participation
• Compliance at the access points
• The 2-Midnight Rule and Observation
• The NOTICE Act
• The Important Message from Medicare
• The HINN
• Utilization management and compliance
• Documenting for compliance
• How to perform a compliance gap analysis
• Compliant UR Committee

As case managers, we must be aware of the myriad of compliance issues that we must adhere to in our daily practice.  Never has this been more important to our work as case managers than it is now.  Our ability to remain compliant has become an element of audits from accrediting bodies such as the Joint Commission as well as the Centers for Medicare and Medicaid Services (CMS).  It is the right thing to do for patients as well.

As a case manager, you may not be up to date on all the compliance issues affecting case managers in the acute care setting. While some of them have been around for years, others are fairly new. Some are directly linked to reimbursement.  By attending this session, you will be able to ensure that you understand the compliance issues directly related to the practice of case management and that you have incorporated them into your daily practice. Compliance includes documentation and communication with the patient and family as well.  Be sure that your processes are hard-wired and part of your daily routine.

• Director of Case Management
• Director of Social Work
• Case Managers
• Social Workers
• Vice President of Case Management
• Director of Quality
• Nursing Director
• Nursing Vice President
• Hospitalist
• Physician Advisor
• Emergency department physicians