2018 Case Management: Complying with the Conditions of Participation and Other Regulatory Requirements

Product Id : HE36
Instructor : Toni G. Cesta
Oct 11, 2018 1:00 PM ET | 12:00 PM CT | 10:00 AM PT | 60 Minutes


Tackle Tough Compliance Areas: Conditions of Participation, the 2-Midnight Rule, the NOTICE Act, the HINN, Changes in Patient Choice, and Much More!

A good outcome from a Joint Commission survey in 2018 is more critical than ever, especially if you want to continue receiving Medicare payments. Case managers must be constantly aware of the myriad of compliance issues that impact your daily practices. Your compliance is under scrutiny during audits by CMS and the Joint Commission, which are paying special attention to the 2-Midnight Rule, the NOTICE Act, HINNs, The Important Message, and other compliance issues.

How can you juggle all these case management concerns? Join expert speaker Dr. Toni Cesta as she shows you how to identify where you may have compliance gaps – and how to fix those problem areas pronto!

After attending this event, you will understand how to maintain compliance in a variety of areas directly related to utilization management and discharge planning. You’ll learn how to survive Joint Commission and CMS audits that are scrutinizing hospitals’ and case management departments’ compliance with the Conditions of Participation and other regulatory requirements. You’ll walk away with the knowledge and tools you need to ensure that your case management and compliance processes are hard-wired and part of your daily routine!

Session Highlights:

With this session, you will learn how to:

  • Identify the hot-button compliance issues for case managers
  • Tackle tough compliance areas like the Conditions of Participation, the 2-Midnight Rule, the NOTICE Act, the HINN, changes in patient choice, and much more
  • Handle compliance at the access points, as well as utilization management and compliance
  • Leverage your documentation practices for compliance – and don’t let sloppy, lackluster documentation ruin your compliance efforts
  • Balance quality and cost, so you’re spending smartly on all the most crucial areas
  • Assemble and maintain a compliant Utilization Review (UR) Committee
  • Perform a compliance gap analysis and use it as your secret weapon!

Session Agenda:

  • Who requires compliance?
  • Compliance shared responsibilities
  • Compliance goals of access point case management changed with 2014 Inpatient Prospective Payment System (IPPS) final rules
  • Observation: The key compliance concept
  • The NOTICE Act
  • Patient notification using the moon
  • The 2 Midnight Rule
  • 2016 outpatient prospective system final rule
  • Vulnerabilities remain under Medicare’s 2-Midnight hospital policy
  • CMS Conditions of Participation for Hospitals (CoPs) 42 C.F.R. part 428
  • Medicare Conditions of Participation (CoPs)
  • Utilization management rules and regulations
  • Important compliance billing processes
  • Incorporate 2 Midnight compliance in to your daily case management routine
  • Self-denial process: Medline matters (MLN matters) MM 8445
  • Hospital Issued Notice of Noncoverage: HINN
  • Current CoPs discharge planning requirements 482.43
  • CMS conditions of participation: Discharge planning 482.43
  • A payer’s compliance expectations
  • Physician’s role in compliance
  • Case management compliance strategies
  • Impact of each case manager on compliance

Who Should Attend:

  • Directors of Case Management
  • Compliance Officers
  • RN Case Managers
  • Directors of Quality Management
  • Directors of Social Work
  • Social Workers
  • Hospitalists
  • Physician Advisors
Speaker Profile:

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, with an eye on structure, process and outcome measures for nurse case managers and social workers.

The author of nine books on case management, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Among her books are included the “The Case Managers Survival Guide” and “Core Skills for Hospital Case Managers”.

Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management newsletter in which she shares insights and information on current issues and trends in case management.  She is a past commissioner for the Commission for Case Management Certification. She has held positions as Senior Vice President, Corporate Vice President, Director of Case Management and professor of case management.

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