Case Management: Find and Fix Your 2018 Compliance Gaps

Duration: 60 Minutes
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.
Case Management
Instructor: Dr. Toni Cesta
Product ID: 507300
Objectives of the Presentation
  • Understand the compliance issues required under the Conditions of Participation for Utilization Management and Discharge Planning
  • Describe your responsibilities as they relate to Observation and the 2-Midnight Rule
  • Your requirements to be compliant with the Important Message from Medicare
  • Explain how the patient choice lists are used
  • Understand the different types of HINNs and when they should be given
  • Document for compliance
Why Should you Attend
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.

This program will review the compliance issues that most greatly impact your practice such as the 2-midnight Rule, the NOTICE Act, HINNs, The Important Message and others. 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!

Areas Covered
  • Compliance overview for case managers
  • Balancing quality and cost
  • The Conditions of Participation
  • Compliance at the access points
  • The 2-Midnight Rule and Observation
  • The NOTICE Act
  • The Important Message from Medicare
  • The HINN
  • Changes in Patient Choice
  • Utilization management and compliance
  • Documenting for compliance
  • How to perform a compliance gap analysis
  • Compliant UR Committee
Who will Benefit
  • Director of Case Management
  • Compliance Officer
  • RN Case Managers
  • Director of Quality Management
  • Director of Social Work
  • Social Workers
  • Hospitalists
  • Physician Advisor
  • Case Management Senior Leaders
  • Directors of Finance
  • Director of case management
  • Case managers
  • Directors of nursing
  • Directors of patient flow
  • Director of revenue cycle
  • Chief financial officers
  • Chief operations officers
  • Chief medical officer
  • Nursing home directors
  • Director of home care
Topic Background
Case managers and social workers need to maintain compliance in a number of areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments for compliance with the Conditions of Participation as well as other regulatory requirements. Every case management professional needs to know how these requirements impact their professional.
$300
Recorded Session for one participant
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How it works
Live Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • The webinar joining link, username and password for joining the webinar will be updated on your OCP Account 24 hours prior to the webinar
  • Presentation handouts in Downloadable PDF format will be updated on your OCP Account 24 hours prior to the live session
  • Login to the audio conference on the scheduled date and time
  • Get answers to your queries through interactive Q&A sessions via chat at the end of the session
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account 24 hours after the completion of the session
  • Please let us know your thoughts and views at the end of the webinar, your valuable feedback will help us improve
Recorded Session - How it works
  • Login to onlinecompliancepanel with your registered username and password https://www.onlinecompliancepanel.com/login
  • Upon purchase of the recorded session a link will be updated on your OCP Account within 24 hours
  • Please click on the link to access the Recorded Session
  • Presentation handouts in downloadable PDF format will be updated on your OCP Account within 24 hours of the purchase of the product
  • Download the Certificate of Attendance and Purchase Invoice from your OCP Account after 48 hours of the product Purchase
  • Please share your valuable Feedback at the end of the session
Instructor Profile:
Toni G. Cesta, Ph.D., RN, FAAN owns and operates Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating case management models in the acute care, emergency department and outpatient settings. Dr. Cesta writes a monthly column called "Case Management Insider" in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management. Dr. Cesta has held positions as Senior Vice President - Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York where 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 Vincent's 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.

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.
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