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 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 touch point 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.
The Centers for Medicare and Medicaid Services (CMS) provides us with two Conditions of Participation that apply to the work of case management professionals. These include the Conditions of Participation for Discharge Planning and the Conditions of Participation for Utilization Review. This webinar will focus on these rules as they apply to the role of utilization review. In order for case management departments to be compliant with these regulations, RN and social work case managers must understand these ‘rules of the road’ for utilization review and work within their boundaries.
In this jam-packed program you will learn how to stream-line your utilization management process as well as understand the Conditions of Participation for Utilization Review and how they impact on your work as a case manager. We will discuss the differences between utilization review and utilization management. The process for incorporating medical necessity into the process of utilization management will be explained. This will be followed by a discussion of the compliance components for utilization review including the utilization management plan, the utilization management committee, Condition Code 44, and the two-midnight rule. How to incorporate the two-midnight rule into your utilization management process. Also explained will be the various types of clinical reviews performed by the case manager.
The various types of Hospital-Issued Notices of Non-Coverage (HINNs) will be described with examples of how they are used. You will learn whether or not your utilization management committee is effective and compliant.
Venue: Recorded Webinar
Imagine the thrill of automating those repetitive Excel tasks that have been draining your productivity. Picture the convenience of effortlessly streamlining complex processes, leaving you with more time to focus on what truly matters. Now, consider the positive impact you can have on your team and clients by offering streamlined, error-free solutions. Excel macros are powerful tools that can transform your Excel experience by automating repetitive tasks, freeing up your time for more important work. If you often find yourself performing the same actions or dealing with time-consuming Excel processes that beg for automation, it's time to dive into the world of macros. In this session, we will explore two methods for creating macros in Excel: The Macro Recorder and The Macro Editor, ensuring you have a comprehensive understanding of both. Objectives By the end of this session, you will have gained proficiency in creating and editing macros using Excel's Macro Recorder and the Macro Editing Tool. Why You Should Attend Mastering macro creation and editing is a crucial skill for advanced Excel users. This knowledge will not only save you valuable time but also benefit your colleagues and clients, as you'll be able to automate various Excel-based tasks and processes. If you've never created macros before, this webinar is for you. Topics covered Best practices for planning your macros Creating macros using the Macro Recorder Saving files as macro-enabled Excel workbooks Executing macros effortlessly Adding a macro-triggering button A comprehensive tour of the Macro Editor Making basic modifications to macros (VBA fundamentals) Leveraging the Personal Macro Workbook to share macros across all your files Who Should Attend? This webinar is designed to kickstart your journey into the world of macros. It's suitable for intermediate-to-advanced Excel users across all industries and job roles. Although we will be using the latest version of Excel for Windows, the majority of the functionalities discussed are applicable to earlier versions of the application as well.
Are you new to Excel and struggling to understand formulas? Are you tired of manually calculating data in Excel spreadsheets? Do you want to learn how to use Excel formulas to streamline your work and save time? If so, this online training session is the perfect solution for you. Think of any scenario that involves addition, subtraction, division or multiplication and that's where you'd use a formula. Once you’ve mastered formulas, you’ll be introduced to functions which are built-in formulas that have been programmed to perform a specific calculation. They can often be used to shorten and simplify what would otherwise be a long-winded manually-entered formula. Why you should attend Excel is an essential tool for anyone who works with data, from entry-level employees to professionals. Knowing how to use Excel formulas can help you streamline your work, increase accuracy, and save time. This training is designed for beginners, so you don't need any prior experience with Excel or formulas to attend. You will leave the session with a solid understanding of the fundamentals of Excel formulas and the confidence to use them in your work. Topics covered Creating basic formulas: addition, subtraction, division, multiplication Using parentheses in formulas - the what and why Copying a formula - the gotchas you need to know about Make formulas logical and understandable by assigning names to your important cells An introduction to functions: SUM, AVERAGE, COUNT and SUBTOTAL The SUMIF and COUNTIF function: Add up and count based on criteria Use TODAY, DATEDIF and NETWORKDAYS to calculate and manipulate dates Use CONCATENATE and TEXTJOIN to combine text from multiple cells Who should attend This training is perfect for beginners who are new to Excel or have limited experience with formulas. Whether you are a student, professional, or simply looking to improve your Excel skills, this training is for you. The training will be delivered using the latest version of Excel for Windows however all of the functionality is also available to users of earlier versions of Excel.
Does your organization consider the strategic, operational, and compliance related impact of human capital decisions on its ability to achieve its business goals and objectives? Does your human capital help your organization achieve its management goals? Are your employment policies and practices creating material risks and liabilities? Are AI issues now affecting your employment practices? This webinar discusses the development and use of HR Audits in answering these questions and in addressing critical risk management and due diligence issues. The threats and risks from human resource management issues are increasing. No longer measured in only fines, penalties, and awards for non-compliance, human resource management affects keys business metrics, including the organization’s valuation and credit rating. Further, improper human resource management can significantly reduce managerial prerogatives and seriously damage the organization’s reputation and employment brand. As a result, HR audits have become an important tool in identifying problem areas and are increasingly evolving from an ad hoc audit activity to a critical element of an organization’s risk management and compliance processes. Numerous external forces and factors have an impact on the demand for and scope of HR audits. First, in the global economy, human capital has become for many organizations the single most important determinant of competitiveness, productivity, sustainability, and profitability. Increasingly, the organization’s human capital is the source of innovation and a driver of business success. Second, a confluence of economic, political, and social factors, including corporate scandals, the failure of organizations to adequately assess risks, and the increasing number of stockholder initiatives, have resulted in increased statutory and regulatory requirements, a call for greater transparency, and increased internal and external audit activity. Third, governmental agencies have become more active — some would argue more aggressive — and have committed more resources to conducting assessments of employment policies and practices. Importantly, the EEOC, the OFCCP, U.S. DOL, and ICE have advised employers that they consider self-assessments and audits a “best practice.” Fourth, AI is no longer used solely as a tool to support HR activities. AI is quickly becoming a critical element of strategic and tactical management activities. It this environment, identifying and assessing human capital related risks have become a critical element of an organization’s success. As a result, an organization’s ability to audit and manage these risks plays an increasing role in helping it succeed. Why You Should Attend HR audits can assist your organization identify the weaknesses and failures of its human resource management and employment practices compliance activities. HR Audits can further help your organization identity critical issues effecting the management of your human capital asset and provide an indication of your organization’s commitment to identifying and ferreting out unlawful practices and processes. Thus, your use of HR audits should consider strategic and tactical issues, identify risks, assess compliance, and develop both quantitative and qualitative methods and measurements to assess those risks. Your HR audit activities should help you assess your organization’s performance and should provide you with data that will allow you to evaluate human capital outcomes. Areas Covered in this Session A discussion of current trends in HR Auditing A discussion of senior management’s HR auditing goals and issues An understanding of the critical components of an HR audit A discussion of economic, political, regulatory, and social factors affecting HR audits A review the use of HR auditing tools A discussion of the development of the HR Audit Scorecard Who will Benefit HR audits and assessments play an increasingly important role in managing an organization. Like other management tools, HR audits help organizations access, manage, and monitor the successes and failures of their use of key resources and help them plan for future requirements. As a result, attendees will gain an understanding of the required elements of improving their organization’s performance. HR professionals Internal and external auditors Business owners Compliance managers Risk managers CEOs CFOs Topic Background HR audits HR auditing HR risk assessments HR compliance
Critical Access Hospitals (CAHs) must comply with the Centers for Medicare & Medicaid Services’ Conditions of Participation located in Appendix W in the manual. This eight-part webinar series will cover the CAH CoP manual. There were changes and new regulations for CAHs in 2020, including a change to all the tag numbers, some which do not include Interpretive Guidelines or Survey Procedures. Changes include infection prevention and control and antibiotic stewardship, QAPI and Swing Bed changes. This seminar will help CAHs comply with specific CoP problem areas, such as nursing care plans, necessary policies and procedures, medication administration and drug storage, and informed consent to name a few. Part Four of Eight: Governing Board, Agreements and Contracted Services, QAPI, Discharge Planning Objectives Describe that CMS requires the Board enter into a written agreement for telemedicine services Describe requirements for contract management for a CAH Describe the essential elements of a QAPI program and Board responsibilities Recall the requirement for when a discharge evaluation must be completed Organizational Structure and Governing Body/Individual Governing body/Individual’s responsibilities Appointment to medical staff Telemedicine services and requirements Required disclosures Agreements and Contracted Services Agreement with providers or suppliers Lab and diagnostic services Food services Quality Assurance Performance Improvement - QAPI Changes to the QAPI program Requirements of a QAPI program QAPI standards Data collection and analysis Reference: Standards and guidelines for Acute hospitals Discharge Planning Need for effective discharge planning process Discharge evaluation and plan Review of discharge planning process Requirement to assist in PAC selection Appendix and Resources