Upcoming Dates and Times
Wednesday, May 1st, 2024 @ Noon
Description
Have you ever found yourself asking:
- Who gets to decide what’s inpatient anyway?
- Who are these Utilization Management (UM) nurses?
- Why am I getting paged to change inpatient/observation status? (Just fix it already!)
- Why does this even matter?
Like it or not, practicing in the ER or the hospital in our current healthcare system means that understanding when inpatient-level acute hospital care is appropriate and then documenting the medical necessity of that care is an obligation we must meet. This has significant consequences if we get it wrong. Did you know it costs our organization about $3,400 per case if we get the status wrong? Additionally, our patients can have significant financial burden with incorrect status (from a higher bill to a lost subacute rehab opportunity to loss of confidence in our system due to confusing/changing messages).
Did you know the Utilization Management (UM) department includes 28 nurses and five UM specialty physicians who are all members of CentraCare? Our organization cannot get it right without partnership between providers and our UM nursing. Our overarching goal is to be a team that succeeds in improving patient experience and reducing loss of reimbursement and administrative burden – all while making the job easier for every member of that team (from providers to UM nurses).
Objectives
Join Dr. Nichole Cummings and Annie Volkers, MHA, BSN, ACM-RN, Director of Utilization Management as they review:
- Criteria supporting inpatient or observation admission status
- Patient descriptors critical to support medical necessity and admission status
- Multidisciplinary cosign process with UM nurses
Presenters
Nichole Cummings, MD, Medical Director of Utilization Management
Annie Volkers, MHA, BSN, ACM-RN, Director of Utilization Management
NOTE:
Identical content is offered at each session under the topic specific sessions; providers need only attend one.
Please RSVP to linnt@centracare.com if you can, though you’re welcome to join no matter what.