This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. Included in this will be a review of the DRG relative weights, case mix index, and expected lengths of stay. Medical record coding will be explained in the context of how hospitals get reimbursed. This will be followed by a discussion of managed care and managed care contracting as well as the various managed care products currently on the market. Also included will be a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touchpoint on the continuum.

A review of the state of the art in case management from both the acute care and community sides will also be discussed as well as the emerging trends that correlate directly with changes in health care reimbursement over time.

Session Outline:-

• Diagnosis-related groups (DRG)
• Medicare
• Medicaid      
• Managed care definition
• Managed care contracting
• Case rate, per diem, and % of charges contracts
• Managed care products
• Bundled payments – Mandatory and voluntary
• The managing cost across the continuum
• The history of case management
• The merging roles of the RN case manager and social worker across the continuum of care
• Acute care case management
• Community-based case management

Learning Objectives:-

• Understand how hospital stays are reimbursed under the DRGs and prospective payment.
• Review managed care, the different products, and what case management’s role is.
• Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).
• Understand the changing roles of case management professionals across the continuum of care.

Why Should You Attend?

As case management professionals, we work with patients who may fall into one or more of the many combinations of healthcare reimbursement in play today, from government payers such as Medicare and Medicaid to managed care and bundled payments. Among our roles is included the responsibility of controlling cost and length of stay. Therefore we must be up-to-date on each and every payment scheme we may come in contact with.  In addition, we are advocates for our patients and families and we must be able to teach and explain to them how the various payment sources will impact them as well. Healthcare reimbursement knowledge is critical to your success as a case management professional.

This webinar will bring you up to speed on what you need to know to be successful in your role as an RN Case Manager or Social Worker. Also included will be the changing landscape of the roles of the social worker and case manager across the continuum of care.

Who Should Attend?

• RN Case Managers
• Social Workers
• Directors of Case Management
• Directors of Social Work
• Post-Acute Care Providers
• Home Care
• Physician Advisors
• Directors of Finance
• Hospitalists
• Directors of Nursing