title: A case management protocol: reducing unnecessary Medicare admissions in Florida.
abstract: The Florida Medicare quality improvement organization implemented a case management project with 20 acute care hospitals to reduce unnecessary Medicare admissions. The project called for hospitals to implement a protocol to assign patients to observation or inpatient admission status. Results of the project showed a 67% reduction in the denial rate for the participating facilities. This relative reduction in denial rates was nearly 3 times greater for the participating facilities as compared to the control facilities. The protocol can easily be adopted by hospitals.
authors.affiliation: Florida Medical Quality Assurance, Inc, 4350 W Cypress St, Suite 900, Tampa, FL 33607, USA. mmichelman@flqio.sdps.org
authors.forename: Mark
authors.initials: M
authors.lastname: Michelman
authors.forename: Patricia
authors.initials: P
authors.lastname: Collier
authors.forename: Charles
authors.initials: C
authors.lastname: Dion
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Richards
authors.forename: Henry
authors.initials: H
authors.lastname: Ohleyer
authors.forename: Paulette
authors.initials: P
authors.lastname: Vasey
authors.forename: Zachary
authors.initials: Z
authors.lastname: Henshaw
authors.forename: Karen
authors.initials: K
authors.lastname: Davison
mesh_terms: D019090:Case Management; D016022:Case-Control Studies; D005431:Florida; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000592:standards*; D014481:United States