The Rac Toolkit For Hospitals And Health Systems

Author : Elizabeth E. Lamkin
Publisher :
ISBN 13 : 9781601468284
Total Pages : 0 pages
Book Rating : 4.88/5 ( download)

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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

Author : Tony Cesta
Publisher : HC Pro, Inc.
ISBN 13 : 1601463537
Total Pages : 319 pages
Book Rating : 4.31/5 ( download)

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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

Author : Elizabeth E. Lamkin
Publisher : Hcpro Incorporated
ISBN 13 : 9781615691388
Total Pages : 126 pages
Book Rating : 4.83/5 ( download)

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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

Author : Pieter Kubben
Publisher : Springer
ISBN 13 : 3319997130
Total Pages : 219 pages
Book Rating : 4.31/5 ( download)

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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.

Author : Michael K. Harrington
Publisher : Jones & Bartlett Learning
ISBN 13 : 1284203298
Total Pages : 344 pages
Book Rating : 4.95/5 ( download)

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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.

Author : Y. Chartier
Publisher : World Health Organization
ISBN 13 : 9241547855
Total Pages : 132 pages
Book Rating : 4.57/5 ( download)

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Download or read book Natural Ventilation for Infection Control in Health-care Settings written by Y. Chartier and published by World Health Organization. This book was released on 2009 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt: This guideline defines ventilation and then natural ventilation. It explores the design requirements for natural ventilation in the context of infection control, describing the basic principles of design, construction, operation and maintenance for an effective natural ventilation system to control infection in health-care settings.

Author : Ruth Bryant
Publisher : Elsevier Health Sciences
ISBN 13 : 0323776361
Total Pages : 851 pages
Book Rating : 4.63/5 ( download)

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Download or read book Acute and Chronic Wounds - E-Book written by Ruth Bryant and published by Elsevier Health Sciences. This book was released on 2023-05-18 with total page 851 pages. Available in PDF, EPUB and Kindle. Book excerpt: Acute & Chronic Wounds, 6th Edition provides the latest diagnostic and treatment guidelines to help novice to expert clinicians provide evidence-based, high-quality care for patients with wounds. This textbook presents an interprofessional approach to maintaining skin integrity and managing the numerous types of skin damage, including topics that range from the physiology of wound healing, general principles of wound management, special patient populations, management of percutaneous tubes, and specific care instructions to program development. Written by respected wound experts Ruth Bryant and Denise Nix, this bestselling reference also provides excellent preparation for all wound certification exams. Comprehensive approach addresses the prevention and management of acute and chronic wounds, making it the preeminent resource for skin health and wound management across all disciplines involved in wound care, from novice to expert. Learning Objectives at the beginning of each chapter emphasize the most important content. Clinical Consult feature in each chapter provides a synthesis of the chapter content, illustrating how to assess, manage, and document a realistic clinical encounter using the ADPIE or SBAR framework. Checklists provide a concise list of actions necessary to achieve the best patient care outcomes or satisfy a particular objective. Practical tools and algorithms help in performing risk assessment, differential diagnosis, classification, treatment, and documentation. Coverage of practice development issues addresses outcomes and productivity in agencies and institutions, home care, acute care, long-term care, and long-term acute care settings. Self-assessment questions help you test your knowledge and prepare for certification exams. Helpful appendices provide answers to self-assessment questions, as well as various tools, policies and procedures, competencies, patient and family education guidance, and more. NEW! Chapters on Postacute Care Settings; Telehealth and Wound Management; Quality Tracking Across the Continuum; and Medications and Phytotherapy: Impact on Wounds provide evidence-based coverage of these important topics. UPDATED! Consolidated pressure injuries content puts everything you need to know into one chapter. Expanded full-color insert includes 50 new images — for a total of 95 color plates with more than 160 images — that visually reinforce key concepts. New information presents the latest developments in biofilm assessment and management, topical oxygen therapy, skin manifestations related to COVID-19, and strategies to enhance engagement, as well as updated product photos and more authors who are clinical experts and providers.

Author : Gill Harvey
Publisher : Routledge
ISBN 13 : 1136768157
Total Pages : 292 pages
Book Rating : 4.56/5 ( download)

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Download or read book Implementing Evidence-Based Practice in Healthcare written by Gill Harvey and published by Routledge. This book was released on 2015-03-24 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt: The successful implementation of evidence into practice is dependent on aligning the available evidence to the particular context through the active ingredient of facilitation. Designed to support the widely recognised PARIHS framework, which works as a guide to plan, action and evaluate the implementation of evidence into practice, this book provides a very practical ‘how-to’ guide for facilitating the whole process. This text discusses: undertaking an initial diagnosis of the context and reaching a consensus on the evidence to be implemented; how to link the research evidence with clinical and patients’ experience and local information in the form of audit data or patient and staff feedback; the range of diagnostic, consensus building and stakeholder consultation methods that can be helpful; a description of facilitator roles and facilitation methods, tools and techniques; some of theories that underpin the PARIHS framework and how these have been integrated to inform a revised version of PARIHS Including internationally-sourced case study examples to illustrate how the facilitation role and facilitation skills have been applied in a range of different health care settings, this is the ideal text for those interested in leading or facilitating evidence based implementation projects, from the planning stage through to evaluation.

Author : United States. Social Security Administration
Publisher :
ISBN 13 :
Total Pages : 72 pages
Book Rating : 4.08/5 ( download)

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Download or read book Conditions of Participation for Hospitals written by United States. Social Security Administration and published by . This book was released on 1966 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Author : Marc T. Braverman
Publisher :
ISBN 13 :
Total Pages : 134 pages
Book Rating : 4.59/5 ( download)

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Download or read book Evaluating Health Promotion Programs written by Marc T. Braverman and published by . This book was released on 1989 with total page 134 pages. Available in PDF, EPUB and Kindle. Book excerpt: