What’s one of the most powerful components of RCM, and one that ensures great financial results for hospitals? Case management consultant Mindy Owen makes an excellent “case” for EDUCATION – – ongoing training of case managers is the key.
Owen is a specialist in educating and developing case management teams, and has traveled across the country teaching case managers about best practices and, as a result, turning around underperforming case management departments.
Health System Management has a great case history showing how Owen diagnosed and fixed a revenue leakage problem at a large Level 1 trauma and academic medical center in the Southwest.
When Owen met with claims payment staff at each of the health plans working with this medial center, she found..
…The claims were incomplete, lacked the proper documentation supporting care and, in some cases, the claims were for medically unnecessary or duplicative interventions.
With this information, Owen saw an opportunity to educate the case management staff to ensure they followed clinically sound utilization management practices and best practices when patients transitioned from the hospital to home or to another facility. Also, she had the care management team work closely with the hospital’s clinical documentation specialists and coding department to improve the timeliness and quality of documentation and coding for claims going to the health insurers. The goal was to ensure all claims were well documented and error-free going forward.
I don’t want to give away the ending, but suffice to say case manager training and ongoing education became integral to patching the leaks and eliminated clinical denials in the millions. The nice thing is, there are tools which can be used to track results seamlessly now.
Training programs aren’t free, but in this case the adage “spend a little; earn a lot” holds up!