Documentation
What is the SDOH Assessment?
This tool allows case managers to document and track social determinants of health.
Such as - transportation, housing, medication needs, and nutrition.
What is the timeframe from admission that the patient must receive an admission IML?
What is 24 hrs?
What is the first step in safe discharge planning?
What is Identify patients NOK/LAP, decision maker, baseline status, current needs, and barriers?
This initial assessment topic helps determine whether the patient may have difficulty obtaining medications after discharge.
What is assessing prescription coverage and medication affordability?
What does CMS stand for?
What is Centers for Medicare and Medicaid Services?
When must a new or updated CM note be placed?
Every 1-2 days not to exceed 3 days.
What does MOON stand for?
What is Medicare Outpatient Observation Notice?
What must be confirmed before discharging a patient to outpatient infusion?
What is Appointment confirmation via our Infusion/CM Communication chat, transportation plan, and patient agreement?
During your initial assessment, this information helps determine the patient's baseline level of function before admission.
What is the patient's prior level of function (PLOF)?
What does CCM stand for?
Hint ask Nilsa :)
What is Certified Case Manager
This key piece of information from MDR should always be included in your ongoing CM note and identifies what the physician states is holding the patient in the hospital.
What is the medical discharge barrier identified by the physician or goal lab?
Before sending an MCT referral for HHC auth needs, what must you print from the Aidin packet draft?
What is Dissemination List?
This discharge barrier occurs when equipment such as oxygen or a walker is ordered on the day of discharge.
What is a DME Delay?
When a patient uses oxygen at home, documenting this information helps determine if their oxygen needs have changed from baseline.
What is the patient's baseline oxygen liter flow?
What is the previous DME supplier name and contact number?
What is the name of our post Huddle education chat where education materials are placed?
When a patient is medically ready but remains hospitalized due to a non-medical barrier, this should be clearly documented / tracked.
What is an avoidable night and CM discharge delay?
A patient receives their DC IM from the CMA before discharge. To remain compliant and avoid a regulatory letter miss, the patient must stay in the hospital for at least this amount of time after receiving the letter.
What is 4 hours?
This referral activity is used when arranging services such as nursing, PT, or OT after discharge.
What is Home Healthcare Referral?
When must the Initial Assessment be completed and documented by?
What is within 24 hrs of admission.
The provider states during MDR that the patient will discharge in 48 hours. Based on Care Management experience, the actual discharge timeframe is usually this.
What is greater than 72 hours?
A note stating only "following" or "continue to monitor" is missing this critical component needed for a complete CM note.
What is a measurable update, intervention, discharge planning progress, or anticipated discharge plan.
This type of list is used when a patient is already receiving care from a specific home health agency or skilled nursing facility and wants to return to that same provider, while still meeting regulatory choice requirements.
What is Dissemination List?
Before a patient can discharge to a Skilled Nursing Facility, documentation should show a bowel movement occurred within this many days of discharge.
What is three days?
During the initial Care Management assessment, a patient is identified as self-pay with no insurance coverage. These three charity and financial assistance referrals should be initiated to help evaluate available resources and support.
What are HFS, CanAide, and Community Care?
How "young" is Shelley? 58?
What is 54?