Download or read book The Rac Toolkit for Hospitals and Health Systems written by Elizabeth E. Lamkin and published by . This book was released on 2011-05-20 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program Amanda W. Berglund, MS, MBA; Elizabeth E. Lamkin, MHA Learn how to respond to RAC audits. And more importantly, how to prevent them. The RAC Toolkit for Hospitals and Health Systems: Manage Responses and Avoid Claims Under the Permanent Program is your answer to turning plans into proactive action for RAC success. Authors Elizabeth E. Lamkin, MHA, and Amanda W. Berglund, MS, MBA, describe how to establish and sustain an effective RAC-preparedness structure that can be adapted to fit any organization's system. They provide best practices for successful processes and outline each staff member's role in your RAC audit program. Whether you are responding to a Recovery Auditor or another government auditor, your program must operate as effectively as possible. You will use their tested, proven, and practical tools that will help you build a more effective billing compliance program. You'll learn how to bring finance, business office and clinical staff together for operational improvements that directly affect your bottom line. The RAC Toolkit for Hospitals and Health Systems will help you get the job done right. The RAC Toolkit for Hospitals and Health Systems will help you achieve the following goals: Take a systemic approach to RAC compliance Incorporate effective structure and processes to existing systems for measurable results Organize committees and facilitate information flow Appeal effectively and within deadlines Use proven tools and methods for an effective RAC program Table of Contents: Chapter 1: RAC Program Overview Chapter 2: Preparing for RAC Chapter 3: The Right Structure: Organizing the Committees Chapter 4: The Right People: Three Critical Roles for RAC Prevention Chapter 5: Additional RAC Stakeholders Chapter 6: Automated Reviews Chapter 7: Complex Review and Extrapolation Chapter 8 The Appeal Appendix (Acronyms and additional resources) Take advantage of these valuable tools included in your book: RAC appeal timeline RAC preparedness checklist RAC committee structure flowchart Organizational chart for RAC-related personnel Sample RAC committee meeting agenda Sample UR committee meeting agenda Complex case review worksheet Admission review continued stay and discharge review flowchart Patient status change letter template Automated review timeline Complex review timeline Appeal letter template for appeal level 1 redetermination CMS form 20027 CMS form 20034 CMS form DAB101

Download or read book The RAC Toolkit for Physician Practices written by Elizabeth E. Lamkin and published by Hcpro Incorporated. This book was released on 2014-05-14 with total page 126 pages. Available in PDF, EPUB and Kindle. Book excerpt: RACs are auditing practices. Learn how to prepare. The RAC Toolkit for Physician Practices is your practice's answer to turning plans into proactive action for RAC success. Authors Elizabeth Lamkin, MHA, and Amanda Berglund, MS, MBA, describe how to establish and sustain an effective RAC-preparedness structure that can be adapted to fit any organization's system. They provide best practices for successful processes and outline each staff member's role in your RAC audit program. Physician practice settings are getting audited by RACs. Whether you're dealing with a RAC or another government auditor, you need a program that's running as effectively as it can be. You will use their tested, proven, and practical tools to build a more effective billing compliance program. You'll learn how to bring finance, business office and clinical groups together for operational improvements that drop right to the bottom line. The RAC Toolkit for Physician Practices will help you get the job done right. The RAC Toolkit for Physician Practices will show you how to: * Take a systemic approach to RAC compliance * Incorporate effective structure and processes to existing systems for measurable results * Organize committees and facilitate information flow * Appeal effectively and within deadlines * Use proven tools and methods for an effective RAC program

Download or read book Core Skills for Hospital Case Managers written by Tony Cesta and published by HC Pro, Inc.. This book was released on 2009-06 with total page 319 pages. Available in PDF, EPUB and Kindle. Book excerpt: Core Skills for Hospital Case Managers: A Training Toolkit for Effective Outcomes Toni Cesta, PhD, RN, FAAN; Beverly Cunningham, MS, RN As of June 20, 2014, contact hours for nurses are no longer available with this product. Finally--an affordable, effective, and consistent training program for your hospital case managers. This one-of-a-kind guide to fundamental case management responsibilities is a necessary reference tool for every hospital case management department. This resource is designed to give case management directors and hospital leaders the tools they need to build and strengthen the basic and advanced skills their case management staff needs to succeed. Core Skills for Hospital Case Managers is an orientation and training manual for nurses transitioning into case management, an easy-to-read reference guide for new case managers, and a source of inspiration, tools, and resources for seasoned professionals. With a flexible format, this book and CD-ROM offer practical information and customizable tools to develop and maintain a wide variety of care management skills. Table of contents Chapter 1: Hospital Case Management 101 Chapter 2: Case Manager Role Chapter 3: Roles, Functions, and Caseloads Chapter 4: The Case Management Process Chapter 5: The Case Manager's Role in Transitional and Discharge Planning Chapter 6: Utilization Management Chapter 7: Managing Long Length of Stay Patients Chapter 8: Denials: Prevention and Appeals Strategies Chapter 9: Reimbursement Chapter 10: The Role of the Case Manager in Patient Flow Chapter 11: Measuring Success: Strategic Outcome Measures Chapter 12: Dealing with the Uninsured and Underinsured Chapter 13: Working with Multidisciplinary Teams Chapter 14: Crucial Communication and Conflict Resolution Learning objectives: Discuss the evolution of hospital case management Explain the different models of hospital case management Determine the various goals of hospital case management Examine the various roles of case management Discuss the variety of functions performed by case managers Discuss the scope of the case manager position Examine staffing ratios in various models List the steps in the case management process Determine the role of case managers in documentation Examine case managers' role in discharge planning List the factors that influence the discharge planning process Determine strategies for improving discharge planning Discuss how hospital reimbursement affects utilization management (UM) List the stages of UM coordination Determine the affect of outside influences on UM Evaluate different payers' regulations regarding UM Examine case management's role in length of stay (LOS) Evaluate strategies for managing patients with long LOS Identify data used to track and trend LOS Evaluate the reasons behind denials Discuss case management's role in preventing denials Examine case management's roles in reversing denials Examine case management's role in reimbursement Determine strategies for effective case management related to reimbursement Evaluate case management's role in patient flow Discuss demand and capacity management Identify strategies for managing patient flow Identify measurable case management outcomes Explain how case managers can track quality outcome metrics Discuss other metrics case management departments can track and trend Examine ways to create a case management report card Discuss the unfunded or underfunded patient populations Describe the role of the ED case manager with unfunded or underfunded patient populations Evaluate strategies for dealing with unfunded or underfunded patient populations Examine strategies for successfully working with multidisciplinary teams Describe sources of conflict with which case managers frequently come in contact Discuss strategies for reducing conflict Intended audience Staff nurses, charge nurses, staff educators, staff development specialists, directors of education, nurse managers, and nurse leaders

Download or read book Tools for Hospitals and Health Care Systems written by and published by . This book was released on 2005 with total page 4 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Fundamentals of Clinical Data Science written by Pieter Kubben and published by Springer. This book was released on 2018-12-21 with total page 219 pages. Available in PDF, EPUB and Kindle. Book excerpt: This open access book comprehensively covers the fundamentals of clinical data science, focusing on data collection, modelling and clinical applications. Topics covered in the first section on data collection include: data sources, data at scale (big data), data stewardship (FAIR data) and related privacy concerns. Aspects of predictive modelling using techniques such as classification, regression or clustering, and prediction model validation will be covered in the second section. The third section covers aspects of (mobile) clinical decision support systems, operational excellence and value-based healthcare. Fundamentals of Clinical Data Science is an essential resource for healthcare professionals and IT consultants intending to develop and refine their skills in personalized medicine, using solutions based on large datasets from electronic health records or telemonitoring programmes. The book’s promise is “no math, no code”and will explain the topics in a style that is optimized for a healthcare audience.

Download or read book Health Care Finance and the Mechanics of Insurance and Reimbursement written by Michael K. Harrington and published by Jones & Bartlett Learning. This book was released on 2019-10-01 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Care Finance and the Mechanics of Insurance and Reimbursement stands apart from other texts on health care finance or health insurance, in that it combines financial principles unique to the health care setting with the methods and process for reimbursement (including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing). It explains the revenue cycle in detail, correlating it with regular management functions; and covers reimbursement from the initial point of care through claim submission and reconciliation. Thoroughly updated for its second edition, this text reflects changes to the Affordable Care Act, Managed Care Organizations, new coding initiatives, new components of the revenue cycle (from reimbursement to compliance), updates to regulations surrounding health care fraud and abuse, changes to the Recovery Audit Contractors (RAC) program, and more.

Download or read book Health Care Delivery and Clinical Science Concepts Methodologies Tools and Applications written by Management Association, Information Resources and published by IGI Global. This book was released on 2017-12-01 with total page 1596 pages. Available in PDF, EPUB and Kindle. Book excerpt: The development of better processes to provide proper healthcare has enhanced contemporary society. By implementing effective collaborative strategies, this ensures proper quality and instruction for both the patient and medical practitioners. Health Care Delivery and Clinical Science: Concepts, Methodologies, Tools, and Applications is a comprehensive reference source for the latest scholarly material on emerging strategies and methods for delivering optimal healthcare and examines the latest techniques and methods of clinical science. Highlighting a range of pertinent topics such as medication management, health literacy, and patient engagement, this multi-volume book is ideally designed for professionals, practitioners, researchers, academics, and graduate students interested in healthcare delivery and clinical science.

Download or read book Patients as Partners written by Jcr and published by Joint Commission on. This book was released on 2007-01-01 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Hospitals Health Care Organizations written by David Edward Marcinko and published by CRC Press. This book was released on 2012-07-06 with total page 417 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today‘s increasingly competi

Download or read book Health Information Systems Concepts Methodologies Tools and Applications written by Rodrigues, Joel J.P.C. and published by IGI Global. This book was released on 2009-12-31 with total page 2311 pages. Available in PDF, EPUB and Kindle. Book excerpt: "This reference set provides a complete understanding of the development of applications and concepts in clinical, patient, and hospital information systems"--Provided by publisher.

Download or read book Emergency and Disaster Management Concepts Methodologies Tools and Applications written by Management Association, Information Resources and published by IGI Global. This book was released on 2018-07-06 with total page 1723 pages. Available in PDF, EPUB and Kindle. Book excerpt: In a world of earthquakes, tsunamis, and terrorist attacks, emergency response plans are crucial to solving problems, overcoming challenges, and restoring and improving communities that have been affected by these catastrophic events. Although the necessity for quick and efficient aid is understood, researchers and professionals continue to strive for the best practices and methodologies to properly handle such significant events. Emergency and Disaster Management: Concepts, Methodologies, Tools, and Applications is an innovative reference source for the latest research on the theoretical and practical components of initiating crisis management and emergency response. Highlighting a range of topics such as preparedness and assessment, aid and relief, and the integration of smart technologies, this multi-volume book is designed for emergency professionals, policy makers, practitioners, academicians, and researchers interested in all aspects of disaster, crisis, and emergency studies.

Download or read book Root Cause Analysis in Health Care written by and published by Joint Commission on. This book was released on 2000-01-01 with total page 174 pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite remarkable advances in almost every field of medicine, an age-old problem continues to haunt health care professionals - the occurence of errors. This book aims to help health care organizations prevent systems failures by using root cause analysis to identify causes of a sentinal event, to implement risk-reduction strategies which decrease the likelihood of a recurrence of the event, and to identify effective and efficient ways of improving performance. Root cause analysis is an effective tool used both reactively to investigate an adverse event that already has occurred, and proactively, to analyze and improve processes and systems before they break down.

Download or read book Health Care Finance and the Mechanics of Insurance and Reimbursement written by Michael K. Harrington and published by Jones & Bartlett Publishers. This book was released on 2015-02-27 with total page 370 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book addresses the methods and process for reimbursement, including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing. With up-to-date coverage of the Affordable Care Act, this text will prepare health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility. Some of the topics covered include: claims processing; the Affordable Care Act; Medicare Prospective Payment System (Inpatient); Medicare Outpatient Prospective Payment Systems (Non-Inpatient); coding for the non-HIM professional; revenue cycle management; healthcare fraud and abuse; electronic health records and meaningful use; government incentive programs; recovery audit contractors student & instructor resources. --

Download or read book Handbook of Healthcare System Scheduling written by Randolph Hall and published by Springer Science & Business Media. This book was released on 2011-11-25 with total page 336 pages. Available in PDF, EPUB and Kindle. Book excerpt: This edited volume captures and communicates the best thinking on how to improve healthcare by improving the delivery of services -- providing care when and where it is needed most -- through application of state-of-the-art scheduling systems. Over 12 chapters, the authors cover aspects of setting appointments, allocating healthcare resources, and planning to ensure that capacity matches needs for care. A central theme of the book is increasing healthcare efficiency so that both the cost of care is reduced and more patients have access to care. This can be accomplished through reduction of idle time, lessening the time needed to provide services and matching resources to the needs where they can have the greatest possible impact on health. Within their chapters, authors address: (1) Use of scheduling to improve healthcare efficiency. (2) Objectives, constraints and mathematical formulations. (3) Key methods and techniques for creating schedules. (4) Recent developments that improve the available problem solving methods. (5) Actual applications, demonstrating how the methods can be used. (6) Future directions in which the field of research is heading. Collectively, the chapters provide a comprehensive state-of-the-art review of models and methods for scheduling the delivery of patient care for all parts of the healthcare system. Chapter topics include setting appointments for ambulatory care and outpatient procedures, surgical scheduling, nurse scheduling, bed management and allocation, medical supply logistics and routing and scheduling for home healthcare.

Download or read book New Tools for Curbing Waste and Fraud in Medicare and Medicaid written by United States. Congress. Senate. Committee on Homeland Security and Governmental Affairs. Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security and published by . This book was released on 2011 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Quality and Safety Walk Rounds written by and published by . This book was released on 2016 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Financial Management of Health Care Organizations written by William N. Zelman and published by John Wiley & Sons. This book was released on 2020-08-11 with total page 708 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thoroughly revised and updated Fifth Edition of Financial Management of Health Care Organizations offers an introduction to the tools and techniques of health care financial management. The book covers a wide range of topics, including information on the health care system and evolving reimbursement methodologies; health care accounting and financial statements; managing cash, billings, and collections; the time value of money and analyzing and financing major capital investments; determining cost and using cost information in decision-making; budgeting and performance measurement; and pricing. The revised edition covers new accounting changes for nonprofit hospitals with respect to net asset accounts, and includes an array of new financial statement problem sets for nonprofit hospitals. These changes also required major changes to the recording of financial transactions and implementing the latest financial ratio benchmarks. With the newest payment developments in the health care landscape, this new edition updates changes to Medicare and commercial payment systems. The passage of the new tax law also impacted hospital capital markets and for-profit hospital tax rates. This latest edition explains the impact of this tax law change on tax-exempt hospital bonds purchased by banks, as well as presenting problem sets featuring the new taxes law. Finally, changes in lease financing reporting are also addressed in this edition.