Compliance Measures for RN Case Managers and Social Workers

Toni Cesta

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Key Points:

1) Compliance is an important part of case management.

2) Compliance requires a balance between quality and cost.

3) Case management professionals must be compliant with the CMS Conditions of Participation.

4) Compliance must take place at all access points of the hospital.

5) Case management professionals must play an active role in being compliant with the 2 Midnight Rule and observation status.

6) The Notice Act requires compliance in new and different ways.

7) The Important Message from Medicare is mandatory.

8) Hospital Issued Notices of Non-Coverage *HINN) must be implemented by the CMS rules.

9) Utilization management is mandated under the Conditions of Participation.

10) Documentation is a key component of compliance.

11) Each case management department should do a compliance gap analysis.

12) Your utilization review committee must maintain compliance.

Description:

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 the 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!

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 then 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

Who will benefit:

  • 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 AdvisorEmergency department physicians

Webinar Events
Live -Coming soon!

Training CD-DVD

Physical CD-DVD of recorded session will be despatched after 72 hrs on completion of payment


Recorded video

Recorded video session



Speaker: Toni Cesta ,

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, new documentation systems, and other strategies for improving care and reducing cost. The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management.


Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.


Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Prior to her position as Senior Vice President at Lutheran Medical Center, Dr. Cesta has held positions as Corporate Vice President for Patient Flow Optimization at the North Shore – Long Island Jewish Health System and Director of Case Management, Saint Vincents Catholic Medical Centers of New York, in New York City and also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.


Dr. Cesta has been active in the research and development of case management for over 25 years. Her research in case management has included two funded studies measuring the effects of a case management model on congestive heart failure and fractured hip patient populations, with measures of patient satisfaction, quality of life, and short and long term clinical perceptions and outcomes.


Dr. Cesta has presented topics on case management at national and international conferences and workshops. Her books include “Nursing Case Management: From Essentials to Advanced Practice Applications”, “The Case Manager’s Survival Guide: Winning Strategies in the New Healthcare Environment”, “The Case Manager’s Survival Guide: Winning Strategies for Clinical Practice”, “Survival Strategies for Nurses in Managed Care” and “Core Skills for Hospital Case Managers”. Dr. Cesta is Consulting Editor of “Hospital Case Management Journal” and “Discharge Planning Advisor”. In addition, she serves as editorial advisory board member of several case management journals and publications including “Strategies for Healthcare Excellence” and “The Journal of Care Management”.


Dr. Cesta has a BS in Biology from Wagner College, a BS in Nursing from Adelphi University, an MA in Nursing Administration from New York University, and a Ph.D. in Nursing Research and Theory Development from New York University.


Dr. Cesta is a Fellow of the American Academy of Nursing. Among her awards are included the “Nursing Service Administration Award” from the New York State Nurses Association, the Jessie M. Scott Award for excellence in research, practice and education from the American Nurses Association, and three “Book of the Year” awards from the American Journal of Nursing. In 2010, she was awarded the Brooklyn Leaders Award from the Arthritis Foundation.


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