Reducing the number of days for which insurers deny payment to the hospital: one primary objective for a newly configured department of case management.
This article describes the formation of a Department of Case Management that has as a primary goal a reduction in the number of patient days for which its hospital is denied payment by managed care companies. The department, comprised of social workers and nurses, reached its goal through work with the hospital finance department, patients and families, payers, community resources, ancillary services and admitting physicians. A comparison of annualized denial comparisons based on quarters from 1996 and 1997 showed that the number of days had been quartered.
Hammer
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Department of Case Management, Montgomery Hospital, Norristown, PA 19401, USA.
Kerson
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D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D012948:Social Work Department, Hospital / Q000458:organization & administration*