Description:-

This program will provide a foundation of knowledge and understanding of the DRG system used as the structure for reimbursement under the Medicare and Medicaid programs. Included in this will be a review of the DRG relative weights, case mix index and expected lengths of stay. Medical record coding will be explained in the context of how hospitals get reimbursed.  A discussion of managed will follow this.

Care and managed care contracting as well as the various managed care products currently on the market. The program will conclude with a discussion on bundled payments and what case management professionals need to know in order to assist their organizations in controlling cost and length of stay in a bundled payment environment where patients may access care and use resources at any touch point on the continuum.

Course Outline:-

• Diagnosis-related groups (DRG)
• Medicare
• Medicaid
• Managed care definition
• Managed care contracting
• Case rate, per diem and % of charges contracts
• Managed care products
• Bundled payments – Mandatory and voluntary
• Managing cost across the continuum
• What case managers need to know while educating patients.

Learning Objectives:-

• Understand how hospital stays are reimbursed under the DRGs and prospective payment.
• Review managed care, the different products and what case management’s role is.
• Discuss bundled payments and other new payment models under the Centers for Medicare and Medicaid Services (CMS).

Why Should You Attend?

As case management professionals, we work with patients who may fall into one or more of the many combinations of healthcare reimbursement in play today, from government payers such as Medicare and Medicaid to managed care and bundled payments. Among our roles is included the responsibility of controlling the cost and length of stay. Therefore we must be up-to-date and in contact with each and every payment scheme.  In addition, we are advocates for our patients and families, and we must be able to teach and explain to them how the various payment sources will impact them as well. Healthcare reimbursement knowledge is critical to your success as a case management professional. This webinar will bring you up to speed on what you need to know to be successful in your role as an RN Case Manager or Social Worker.

Who Should Attend?

• Director of Case Management
• RN Case Managers
• Director of Finance
• Director of Social Work
• Social Workers
• Hospitalists
• Physician Advisors
• Directors of Nursing