OVERVIEW

Bundled Payments and Case Management in Hospitals is organized by Skillacquire and will be held on Mar 06, 2019.

Suggested Attendees:
• Director of Case Management
• Case Manager
• RN Case Managers
• Social Workers
• Physician Advisors
• Vice President of Case Management
• Directors of Patient Centered Medical Homes
• Home Care Directors and Managers
• Home Care Case Managers
• Community-Based Providers
• Directors of Nursing
• Directors of Ambulatory Programs
• Directors of Quality
• Directors of Finance

Description:
In the past the revenue cycle was considered to be impacted only by Patient Access, Finance and Billing Departments. It was an effort to ensure payment by the payer and there were rare denials for payments. As healthcare has evolved, there have been significant changes in the revenue cycle. Case Management has become more involved, ensuring their utilization management efforts follow payer contracts, as well as state and federal regulations. Reimbursement has also become driven more by medical necessity criteria and quality outcomes. Payment is not always related to medical necessity criteria, but rather related to payment for not doing the right thing for the patient. While RN case managers, social workers and case management leaders are all key stakeholders in the hospital’s revenue cycle, they are key stakeholders in the hospital’s reimbursement cycle.

Payment has transitioned from per diem payment to case rate payment to value-based reimbursement to now, the challenge of the hospital and other healthcare providers bearing risk for ensuring patients have both quality and cost outcomes met. We see this in accountable care organizations, patient centered medical homes and bundled payments. Even physicians are now risk-bearing in their practices.

Bundled payments, where the risk is aligned with a provider, or group of providers, was first introduced as an optional program. That program advanced from a mandatory bundled payment program to a reduction in the number of mandatory bundled payment hospitals, to current inclusion of many optional bundled payment initiatives. A few of these are outpatient—a very new approach to bundled payments.

This webinar will focus on the bundled payment program process and the role for the case management department. Roles for the case management leader, RN case managers and social workers will be discussed. Additionally, the value of case management’s participation in a bundled payment program will be discussed, through emphasis of a dashboard to ensure improvements are made when appropriate.

Session Objectives:

Participant will be able to learn:
• Understand the revenue and reimbursement cycles and the impact of the case management department
• Identify and implement strategies to optimize case management’s impact on the revenue and reimbursement cycles
• Recognize the transition of the bundled payment program to today’s initiatives
• Appreciate the effectiveness of case management collaboration on bundled payment programs
• Develop appropriate roles to support your bundled payment program
• Develop a strategy to prepare for future mandatory bundled payments

Session Agenda:
• The transition of payer payments from payment for care provided to risk-bearing by providers
• History of bundled payments
• Payment
• Quality eligibility requirements
• Exceptions to bundled payment rule
• Impact of bundled payment on Medicare beneficiaries
• Compliance and the bundled payment process
• Appeal process and procedure
• Developing your bundled payment steering committee
• Role of case management leaders in bundled payments
• Role of case management staff in bundled payments
• Collaboration with physicians
• The role of the physician advisor in a bundled payment program
• Aligning with the community provider
• Working with your Medicare beneficiaries
• Developing your bundled payment dashboard