Case managers reorganize to challenge claims denials.
A combination of diminished reimbursement, decreased funding for residency programs, an epidemic of claims denials, and the skilled nursing crisis has imperiled teaching hospitals across the country. Increasingly, these hospitals are looking to case management departments as potential saviors. In the short term, that could mean more staff and a beefier budget, but if your department can't produce, cuts later on could be drastic. The University of Pennsylvania Health System in Philadelphia lost $90 million in FY1998 and responded by cutting 1,100 positions--9% of its work force. The case management department lost eight positions and is trying to take up the slack with a massive reorganization of its care delivery system and a rigorous education program designed to reduce claims denials. At Georgetown University Medical Center in Washington, DC, however, case management staff and resources have been increased for now. The department is using its new-found prosperity to thoroughly screen all incoming patients for appropriateness of admission, upgrade its discharge planning capabilities, and hire a full-time employee to appeal denied claims.
D000046:Academic Medical Centers / Q000191:economics; D000368:Aged; D019090:Case Management / Q000191:economics*; D004219:District of Columbia; D004608:Eligibility Determination; D006748:Hospital Departments / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review / Q000639:trends*; D007349:Insurance, Health, Reimbursement; D007396:Internship and Residency / Q000191:economics; D016344:Medicare Part A / Q000458:organization & administration*; D014481:United States