The Importance of Case Management in Healthcare

As you know, the role of the case manager is vital to the success of your facility or hospital and can help with everything from compliance to improving your revenue cycle.

Check out all the amazing things case managers do for your facility and how they can help improve your revenue cycle.

The Complex Role of a Case Manager

Case managers can play a critical role in the success of your healthcare facility, whether you are a large hospital or smaller clinic.

The medical journal, For The Record asserts that among the many benefits of having a case manager or two on your payroll is their “ability to effectively guide the patient through his or her stay, reduce fragmentation in care delivery, and increase the quality of services provided.”

Oddly enough, despite how important the role of a case manager is and always has been, healthcare facilities didn’t truly understand their value until “the 1980s when reimbursement shifted from fee for service to diagnosis-related groups.” 

What Case Managers Can Do For Your Health Care Facility

1. Ensure Compliance

According to For The Record, “case managers are crucial in terms of maintaining compliance.” The case management team ensures compliance by preventing readmissions, determining medical necessity and patient status, and making sure healthcare facilities comply with the Centers for Medicare & Medicaid Services’ 48-hour requirement for inpatient status as outlined in the Inpatient Prospective Payment System final rule.

2. Ensure Correct Coding

The case management team ensures correct coding for patients, which in turn, ensures proper reimbursement, which helps improve your facility’s revenue cycle.

3. Save Healthcare Facilities Money

Case managers have a vital impact on a hospital’s financial status by providing  discharge planning of complex patients that decreases length of stay, which increases revenue for the hospital, which is also beneficial for your revenue cycle.

4. Work with Insurance Companies

Case managers work on the front lines by getting a patient’s hospital stay approved by insurance. They also ensure that a patient meets any medical necessity guidelines an insurance company may require.

The case management team also helps with inpatient denials to facilitate either a timely discharge or assist with getting denials overturned by the patient’s insurance company.

5. Facilitate Discharge Planning

According to the Case Management Society of America (CMSA), case managers “have a unique opportunity to lead the charge in developing an individualized and comprehensive care transition plan that meets the needs of the individual across the continuum of care.” One of their main jobs is to help with transition of care facilitation. This means that if a patient needs to go to a nursing home, special rehab clinic, or a long-term care hospital, the case manager facilitates the patient’s transition from the hospital to the new facility.

Case managers also handle other “important things,” like making sure patients are sent home with the correct medical equipment or medication.

Another important job of the case manager is to be a patient’s advocate. This means that the case manager will not “allow a discharge to occur that is not safe.” While case managers aim to decrease hospital stays for patients, they will not do so unless it is safe for the patient to be discharged.

6. Find Resources For Uninsured Patients

Case managers also help uninsured patients by finding them resources. They connect uninsured patients with free outpatient followup clinics and medication programs. They can also help get uninsured patients discharged from the hospital sooner, which helps cut down on loss of revenue.

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Find The Right Person Today!

If you decide you want to enhance your case management efforts, the Nearterm team can help. We have a talented pool of experienced case managers that are ready to enhance the overall care of your patients. To learn more about Nearterm and the different services we offer, just give us a call at (281) 646-1330.