HCC is partnered with our sister company Case Management Innovations, for case management. CMI offers facilities a solution with a 24/7 remote call center that provides quality, first-level admission reviews and education for your staff and providers. This solution is much more cost-effective than adding staff. It has a significant potential return on investment by ensuring that legitimate admissions are recognized while improper admissions, typically targeted by auditors, are avoided. Our process is straightforward, and rapid turnaround keeps patients moving and your throughput times down.
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Case Management
Our Case Management solution is included as part of our comprehensive services.
Case Management Innovations can also be utilized as a standalone service.
While HCC offers case management offers ED as part of our services. Case Management Innovations is a company that supports Case Managers and Utilization Review Managers by providing 24/7 remote coverage. If you’d like to learn more about how Case Management Innovations can serve your facility, find out more here.
Hospital Cases
Hospital Care Consultants educate case managers and physicians to improve documentation and assist with getting the patient into the correct disposition status. As part of our program management, we have various services, consultations, and on-site or online educational training for physicians and case management professionals. Clinical leadership, facility input, or documentation audits often reveal opportunities for improvement at your facility.
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Our Team
Our team of case managers is extensive. A team includes clinical nurses, physicians, billing and coding specialists, healthcare administrators and attorneys. Everyone will be focused on providing the tools and services needed to ensure the appropriate patient flow from the admission through any potential denial periods.
Improper Admissions
The problem we face today is that approximately 60% of admissions from the emergency department occur after traditional business hours when most hospitals do not have case management services to assist with the level of care decisions. the risk of getting it wrong can be costly. CMS estimates $5.7 billion in improper payments related to improper admissions.
Admission Review
HCC offers admission reviews 24 hours per day, 365 days per year. Not only does this ensure proper admissions and categorization of patients, but this will also save the case manager substantial time when attempting to manage errors that occurred overnight or over the weekend. These solutions are very beneficial to our facilities.
- Remote case management support 24/7 for guideline review for admissions
- Confirm the appropriateness of admissions
- Capture appropriate admissions
- Improve level of care determinations
Documentation Support
- Training physicians on Physician certification
- Supporting level of care
- Minimizing RAC vulnerabilities
RAC Preparedness Audits
Mock Recovery Audit Contractor (RAC) audits to determine a facility’s vulnerabilities for RAC denials. Subsequent recommendations for improvement to minimize the potential for denials.
RAC Appeals
Phone call follow up for discharged patients to confirm that they have full understanding of their discharge plan to reduce readmissions
*Note: service and/or training costs may not be included within facility contract.
Policy/Procedure Support
- Condition Code 44
- Post-discharge Reviews
- Physician Certification
RAC Appeals
- Complete RAC appeal process management through three levels of appeal.
- Support the organizations internal RAC appeal process with expert review and letters of support.