Attend this webinar to understand hospital utilization management despite demanding payers doing everything they can to deny payment through denial of medical necessity. Learn about the best model of case management, denial management, and best practices in clinical reviews.
Denial management requires critical thinking by RN case manager and can be both time-sensitive and time-consuming. Payer rules and regulations drive the need for timeliness of the UM process. Rules and regulations by different payers are challenging to both understand and operationalize.
The relationship of physicians to the UM process is critical. Engaged and effective attending physicians, consulting physicians and physician advisors are key in a successful case management program.
Why Should You Attend:
Utilization management is a challenging process. Payers are demanding and are doing everything they can to deny payment through denial of medical necessity. Case management leaders struggle with determining the best model of case management, the optimal roles and the place where utilization management should reside - as a functional role of a bedside RN case manager or separate from that role.Denial management requires critical thinking by RN case manager and can be both time-sensitive and time-consuming. Payer rules and regulations drive the need for timeliness of the UM process. Rules and regulations by different payers are challenging to both understand and operationalize.
The relationship of physicians to the UM process is critical. Engaged and effective attending physicians, consulting physicians and physician advisors are key in a successful case management program.
Areas Covered in the Webinar:
- Definition of utilization management
- Essential case management department roles related to utilization management
- Utilization management and billing and reimbursement
- Rules and regulations affective UM processes
- Best practice in clinical reviews
- The best place to manage UM: bedside or separated from bedside RN case manager function (integrated and triad models of UM)
- Appropriate UM documentation
- Physician utilization management
- Physician advisor role in UM
- Incorporating UM into your daily routine
- Managing denials before they happen: denial and appeal key functions
- The appeals coordinator
- UMs future: Artificial Intelligence
Who Will Benefit:
- Directors of Case Management
- RN Case Managers
- Social Work Case Managers
- Directors of Finance
- Directors of Social Work
- Physician Advisors
- Chief Medical Officers
- Any Executive Responsible for Case Management
Speaker
Bev CunninghamCourse Provider
Bev Cunningham,
