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Closing the Gap Between Case Managers and Coders

Guide to Senior Care Options & Patient Care Assisted / Alzheimer’s – Home Healthcare – Hospice – Home Care Senior Living - Skilled Nursing & Rehabilitation – Rehabilitation Hospital MOBILE  AND  DIGITAL  AVALIABLE    

   

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CONTENTS

Volume 2 Issue 1

Austin

There’s a communications gap between case managers and coders that generally reveals itself too late in the patient-transition process: CONTINUUM OF CARE 4 Senior Living community which provides multi-level of senior living options including rehabilitation services, and home healthcare. HOME HEALTHCARE 6 Allowing patients to remain at home eliminating travel for treatment; alternative to hospital stay or a skilled nursing facility. HOSPICE 8 In-home or facility end of life care for the terminally ill with pain management, comfort and emotional support being the primary mission for the family and regain independence. REHABILITATION HOSPITAL 9 Inpatient rehabilitation hospitals devoted to the rehabilitation of patients with various neurological and orthopedic, and other medical condition to regain strength and stabilization. SKILLED NURSING & REHAB 10 Licensed and equipped to provide healthcare to meet the needs of more extensive medical issues and to regain mobility, strength, and assist in  living after surgery. 3      

PRIVATE DUTY NURSING 14 Providing 1-on1 nursing care in the home from register nurses (RNs) or

Logon to our website for additional information on • • •

Senior Companies Newsletters Upcoming events

casemanagementsocialwork.com facebook.com/casemgmt Copyright © Case Management-Social Work LLC, all rights reserved. No part of this guide may be reproduced or transmitted in any form or by any means without written permission from Case Management-Social Work LLC. Printed in the USA. CASEMANAGEMENTSOCIALWORK.COM


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Continuum of Care Â

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Comfortable. Casual. Complete. Discover a new brand of Life Care retirement living at Longhorn Village.

t CFBVUJGVMMZEFTJHOFECFESPPN BQBSUNFOUT QMVTMVYVSJPVTWJMMBTJEFBMMZ MPDBUFEJO4UFJOFS3BODI t ćF)FBMUI$BSF$FOUFSBU-POHIPSO7JMMBHF  XJUIPOTJUFBTTJTUFEMJWJOHBOENFNPSZDBSF  MPOHUFSNTLJMMFEOVSTJOHDBSFBOETIPSUUFSN SFIBCJMJUBUJPO $BMM(512) 382-4680PS(877) 266-5605UPEBZGPSNPSF JOGPSNBUJPOPSUPTDIFEVMFZPVSQFSTPOBMUPVS

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www.longhornvillage.com

%Ä˛ĹƒÄ˛ÄšÄźÄ˝Ä˛ÄąĜĝ"ŀŀğİĜĎŠĜğĝńĜŠľ5ľIJ&Ĺ…4ŠłĹIJĝŠŀ"ŀŀğİĜĎŠĜğĝğij5ľIJ6ÄťÄśĹƒÄ˛ÄżĹ€ÄśĹ Ĺ†ğij5IJŅĎŀ The Longhorn Village lifestyle is open to everyone regardless of university affiliation.

PLEASE SAY; I FOUND YOU IN CASEMANAGEMENT SOCIALWORK

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HOME HEALTHCARE

Prevent hospital readmissions ResCare HomeCare is your solution Skilled Nursing Complex Medical Care Physical, Occupational & Speech Therapies Discharge your patients smoothly. Get them on a path to a speedy recovery while at home — where we all want to be.

512.794.0995 ResCareHomeCare.com

 

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HOME HEALTHCARE

www.HomeHealthAustin.com

9015 Mountain Ridge Dr. St.210 Austin,Tx 78759 Phone 512.467.6900 Fax 512.467.6906

Counties Served

Travis | Williamson | Llano Burnet | Bastrop | Comal Lee | Fayette | Hays

Customer Services

Medical Services

tMajor Insurances Accepted tAll patients seen within 48 hours of discharge tReferrals taken 24/7 tAccredited by the Joint Commission

tSkilled Nursing tSpeech Therapy tPhysical Therapy tMedical Social Work tOccupational Therapy tHome Care Aide Service tMedication Management

A Family You Can Trust

Family Owned & Operated Capitol Home Health www.HomeHealthAustin.com Phone 512.467.6900 Fax 512.467.6906

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HOME HEALTHCARE

 

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HOSPICE

PLEASE SAY; I FOUND YOU IN CASEMANAGEMENT SOCIALWORK

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SKILLED NURSING & REHAB

A name you can trust for rehabilitation and health care.

Post-Surgical, Short-Term Rehab Heartland - Austin Heartland - Bedford ManorCare - Dallas Heartland - Fort Worth Heartland - North Richland Hills Heartland - San Antonio Heartland - San Antonio North ManorCare - Sharpview ManorCare - Webster ManorCare - West Houston ManorCare - Willowbrook

800.736.4427 www.hcr-manorcare.com

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SKILLED NURSING & REHAB

 

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Closing the Gap Between Case Managers & Coders As if case managers don’t have enough to do. There’s a communications gap between case managers and coders that generally reveals itself too late in the patient-transition process: after the patient’s been discharged and when an auditor is eyeing discrepancies to flag. Fixing that is like shutting the barn door after the horse is gone. Case managers, though, are well-positioned to eliminate that communications gap. After all, case managers have the information about the patient’s discharge status and all other facets of that discharge that can affect reimbursement: where the patient ultimately went, to what level of care and when the services started. Coders forced to rely on what the physician initially ordered for post-acute care may not have specifics about the actual PLEASE SAY; I FOUND YOU IN CASEMANAGEMENT SOCIALWORK

discharge. Case managers who facilitate the transition of care, however, do have that information and must ensure that coders get it too. Otherwise the wrong discharge codes entered in a patient’s claim for payment can result in financial or legal penalties. Or both.  

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It’s Not a Turf War. It’s a Fight for What’s Right.

  Yes, assigning a discharge code is the responsibility of coding professionals. Yet it’s case managers who know the details and appreciate the importance of clear documentation on the revenue cycle and other issues of post-acute care. But it’s not enough to know the facts: Case managers need to communicate to coders what they know and when, and that’s at the time of discharge.   For example, it makes a difference in coding when a patient is transferred to a skilled nursing facility (SNF) for extended care for rehabilitation, or to custodial care or hospice. It also makes a difference if the medical record shows a referral was made to a SNF (Code 03) and the patient subsequently was discharged to a family member with no referral (Code 01). Discharge status codes are used for assignment of MS-DRGs, monitoring the post-acute transfer policy, tracking referral types, readmission analysis and tracking network usage and leakage, among other things. To assign the correct MS-DRG for a Medicare patient, the age, sex, discharge status, principal diagnosis, secondary diagnosis and procedures performed are reported. Notice that discharge status has equal weight with diagnosis and procedures; not everyone appreciates that. One way to improve the accuracy of coding is to increase awareness about its importance and to discuss it with coders and case managers. Ideally, that discussion is coupled with an electronic records system that captures in a structured workflow the most up-todate information, from start of care to level of care, that has an immediate and significant impact on getting claims processed without incident. Jackie Birmingham, RN, MS

 

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PRIVATE DUTY NURSING

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! “Happily Ever After in Case

Management…..

Making Dreams Come True” !

It’s not just any Fairy Tale….. It’s a journey through the Land of Enchantment.

April 10, 2014

FOR!MORE!INFORMATION!TO!ATTEND!OR!EXHIBIT/SPONSOR! www.austin:cmsa.org!

 

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Austin Case Management Social Work  

There’s a communications gap between case managers and coders that generally reveals itself too late in the patient-transition process:

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