Every year there are a slew of regulations released that affect the daily work of case management and utilization review staff. In this session, we will review all new regulations that are certain to cause consternation for the next year for physicians, case managers, and utilization review staff. The content will be updated as new regulations appear so that the content will be current.
At the end of the presentation, the learner is able to:
- Identify regulations that affect case managers, social workers, and utilization review staff.
- Explain the application of new guidance on admission orders
- Describe how to determine status for hospital patients
- Compare the similarities and differences between Medicare, Medicare Advantage, and commercial insurance programs.
- Plan how to obey state and federal laws and unique requirements of reimbursement systems as per Principal 7 of the CCMC Code of Professional Conduct. (Board-Certified Case Managers [CCMs] will obey all laws and regulations.)
Dr. Ronald Hirsch is a Vice President of the Regulations and Education Group at R1 Physician Advisory Services. He received his medical degree from the Chicago Medical School in North Chicago, IL, and completed his internal medicine residency at Kaiser Permanente Medical Center in Hollywood, CA.
Dr. Hirsch is certified in Health Care Quality and Management by the American Board of Quality Assurance and Utilization Review Physicians, is a member of the American Case Management Association, on the Advisory Board of the American College of Physician Advisors, a Fellow of the American College of Physicians, and on the advisory board of the National Association of HealthcareRevenue Integrity.