This classic resource offers complete coverage of nursing case
management - from theoretical background and historical perspective
to practical applications and how the field is changing to meet the
challenges of today's health care environment. It focuses on the
implementation of various case management models used throughout
the United States and abroad. Key topics include the impact of
public policy on health care; understanding the effects of health
care reimbursement and its application at the patient level;
throughput and capacity management; the impact of the revenue
cycle; compliance and regulatory issues; and principles needed to
improve case manager-client interaction. This helpful resource is
designed to help nurse case managers assess their organization's
readiness for case management, prepare and implement a plan to
achieve necessary improvements and evaluate the plan's success.
Includes numerous proven case management models currently being
used in institutions across the country Organized to take the
nursing case manager on a journey from the historical development
of nursing case management to the successful implementation of a
case management program Offers detailed guidance for planning,
implementing, and evaluating a case management program Outlines the
planning process with information on key topics such as analysis of
the organization, the role of the organization's members, selection
criteria for new case managers, case management education,
credentialing, and partnerships Features guidelines for
implementing a case management program with information on ethical
issues, technology, compliance, and regulatory issues Addresses the
evaluation component of developing and implementing a case
management program by presenting information on outcomes, research,
documentation, continuous quality improvement, measuring cost
effectiveness, care continuum, and evidence-based practice Presents
acute care and community based models of case management Highlights
the evolution of collaborative models of case management,
addressing key elements of joint decision-making, shared
accountability, and interdisciplinary systems of care Addresses
health care delivery through case management and public policy by
presenting current legislative issues and their affect on both
health care reimbursement and the application of care at the
patient level Presents the insights, experiences, and advice of
nursing administrators who have researched and successfully
implemented nursing case management programs in various facilities
A new chapter, Telehealth Applications for Case Management,
introduces the concept of telehealth; provides examples of
telehealth usage in women's health, chronic disease management, and
mental health; and summarizes the evidence that supports telehealth
and identifies existing issues and challenges. Case Management:
Life at the Intersection of Margin and Mission, is a new chapter
that highlights strategies case managers and others can use to
optimize their organizations' financial outcomes while
simultaneously improving clinical outcomes for their patients. It
emphasizes the work of case managers in the financial arena of
health care, including revenue cycle management. A new chapter,
Maximizing Reimbursement through Accurate Documentation and Coding,
provides tips and strategies on maximizing reimbursement by
designing and implementing programs focused on improving the
physician's documentation. Effective Management Tools for Case
Management Leaders: Strategy Maps and Balanced Scorecards, A Case
Study is a new chapter that discusses strategy maps and balanced
scorecards and their role in transforming an organization's mission
and strategy into a management system and a comprehensive set of
performance measures. Features updated information on HIPPA
regulation (Health Insurance Portability and Accountability Act),
patient safety and confidentiality issues, case management for
Medicare patients, Medicare legislation, and utilization
management.
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