CMs should understand financial side as well as clinical side of healthcare, experts recommend.
To do their job effectively, case managers must understand the financial side of healthcare and the impact that their actions can have on patient care, the patient's out- of-pocket expenses, and the hospital's bottom line. Recommendations from experts include the following: Communicate and meet regularly with the financial department to identify areas for improvement, and provide input on contracts with payers. Know what benefits each patient's coverage provides and use the information to coordinate care while the patient is in the hospital and to develop a treatment plan. Be aware of payer requirements and be sure that they are followed to avoid denials.
D000288:Administrative Personnel; D019090:Case Management / Q000458:organization & administration*; D004608:Eligibility Determination / Q000191:economics; D006801:Humans; D007342:Insurance Benefits; D005791:Patient Care / Q000191:economics*; D014481:United States