Foundations in Case Management: Medicare Reimbursement, Value-Based Purchasing, Bundled Payments and More

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. This will be followed by a discussion of managed care and managed care contracting as well as the various managed care products currently on the market.

Also, included will be a discussion on bundled payments and what case management professionals need to know 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.

A review of the state of the art in case management from both the acute care and community sides will also be discussed as well as the emerging trends that correlate directly with changes in health care reimbursement over time.

Webinar Objectives

• Understand the components of the Medicare Prospective Payment System including DRGs and its relevance to case management.
• Describe value-based purchasing and case management.
• Review the elements of bundled payments including managing cost and length of stay
• Discuss managed care contracting.
• Understand how Case Management can be applied across the continuum and how reimbursement has shaped those trends.

Webinar Highlights

• 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

Who Should Attend

• RN Case Managers
• Social Workers
• Directors of Case Management
• Directors of Social Work
• Post-Acute Care Providers
• Home Care
• Physician Advisors
• Directors of Finance
• Hospitalists
• Directors of Nursing