UM
This set of criteria used for level of care decision making dates back 30 years and originated in Newton MA.
What is InterQual?
According to CMSA, this is is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.
What is Case Management?
This type of health care vendor provides this category of equipment such as wheelchairs and commodes.
What is Durable Medical Equipment (DME)?
Psychiatry RS in FY19 completed this process 1900 times.
What is finding psychiatric services/bed placement?
This outdated technology is widely used in health care to transmit protected health information (HPI) to payers, PCPs and a variety of agencies that help with transitions of care.
What is faxing?
This process involves reading an electronic medical record to make an assessment of level of care, appropriateness of admission, and/or continued stay and often involves sending a written summary to the payer.
What is a Clinical Review?
This organization oversees the most common type of CM certification as well as updates CM Competencies every 5 years.
What is the Commission for Case Manager Certification?
Working with Case Managers the CMA's completed close to 400 of these in FY17 and again in FY18 before the patients set foot in the hospital!
What are pre- admission assessments?
The Psych RS are the department experts in the use of this application's comprehensive database for insurance coverage look ups.
What is Trizetto?
The passage in 1965 of this legislation was responsible for the birth of Medicare and the Centers for Medicaid and Medicare(CMS)regulatory organization.
What are the Social Security Act Amendments?
In FY18, BCH had received 506 of these dreaded communications and as of now in FY19 we've received 659 - a 30% increase!
What is a denial (clinical)?
BCH Case Managers completed this case finding process more than 18,000 times in FY19.
What is screening?
This application delivers hospital referral requests in a secure HIPPA - comliant format.
What is Ensocare?
This program provides a "step down" residential level of care for patients at the BCH Waltham location.
What is the Community Based Acute Treatment (CBAT) program?
This CMS regulation seeks to provide in writing information that assures that patients in the hospital understand their right to appeal decisions to discharge that they do not agree with.
What is the Important Message from Medicare?
In FY19 a total of 425 these were completed with a combined total over FY18 and 19 of $2.7 million recovered.
What are appeals?
This type of organization is charged with combining comprehensive health care management and payment for services with a goal of best outcomes and patient experience, and cost control.
What are ACO's (Accountable Care Organizations)
This was a common acronym for Medicare and Medicaid certified home care nursing agencies after district nurses and before the current trend toward merging corporate models.
What are Visiting Nurses Associations (VNAs)?
The Psychiatry RS team works closely with clinicians from both the Emergency Psychiatry Service(EPS)this other group that cares for people on patient care units.
What is the Psychiatry Consult Service(PCS)?
This past BCH title preceded "Case Manager" for nurses who practicing the science and art of the CM process including screening, assessing, stratifying risk, planning, implementing, following-up, transitioning, post-transitioning communication, and evaluating outcomes.
What is a PCC - Patient Care Coordinator?
Generally a 24 to 48 hour stay that involves continued evaluation and observation to decide if a person needs to be admitted as an inpatient.
What is Observation Services?
According to the CCMC, this is the process ensures a timely, appropriate, and safe discharge to the next level of care or setting including appropriate use of resources necessary for ongoing care.
What is discharge planning?
BCH CMA's are role models for using this secure communication application linked to the Cerner EMR and the preferred method for CMA requests.
What is Message Center?
This mandate was created collaboratively by the MA DPH, MA Behavioral Health Partnership and the MA Hospital Association Behavioral Health advocates to try to ease the burden or people filling MA emergency departments awaiting appropriate care.
What is the MA EPIA - Emergency Psychiatric Inpatient Admission mandate?
Seeking to assure that Medicare patients understand the implications of being placed in observation services, what do the initials of the MOON stand for?
What is the Medicare Outpatient Observation Notification?