The Case Management Leader's Role in Auditing for Compliance: How to Know What You Don't Know?


Instructor: Bev Cunningham
Product ID: 705460
Training Level: Basic to Intermediate

  • Duration: 60 Min

The webinar will focus on critical rules and regulations that are applicable to the case management department, optimal processes to meet these regulations and the auditing procedure to obtain results for meeting them.

It will assist the case management department leader(s) in identifying required elements of compliance that must be measured. Critical compliance metrics which must be audited and reported to the appropriate staff member or group(s) will be identified.

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Why Should You Attend:

This webinar will introduce the rules and regulations that are applicable to the case management department. Throughout the discussion of these compliance rules and regulations, the instructor will include the process for which each should be audited.

Best practices in these audits, and the very important role of implementing improvements for compliance metrics that do not meet the standard will also be discussed. Collaboration with physicians and partnering with key stakeholders, such as nursing and ancillary services will be reviewed, as not all of these compliance requirements are the totally responsibility of the case management team.

Areas Covered in the Webinar:

  • Why audit
  • The risk of not auditing
  • Review of compliance metrics
  • Critical strategies to audit compliance metrics
  • The role of automation in auditing compliance metrics
  • Integrating case management staff in peer auditing
  • Educating physicians regarding compliance
  • Providing feedback after the audit
  • The role of the Utilization Management Committee in reviewing compliance metrics and recommending strategies to improve results
  • Review the role of the physician advisor in auditing physician compliance results (for example, the two midnight rule)
  • Transitioning from not knowing what is happening in your department to knowing, and improving your compliance metrics

Who Will Benefit:

  • RN case mangers
  • Case management leaders
  • Appeal and denial case managers
  • Utilization review nurses
  • Non-case management department staff who participate in compliance
Instructor Profile:
Beverly Cunningham

Beverly Cunningham
Consultant, Case Management Concepts LLC

Bev Cunningham is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has written a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

Topic Background:

Rules and regulations by CMS, our payers, hospital accreditation agencies and the Conditions of Participation have grown exponentially over the past 10 years. Through this growth, it is difficult to ensure we are following these rules and regulations. Often the case management leader is not aware that compliance is not fulfilled by the staff in their department until denials are issued or penalties are identified through an audit by any of the agencies that have put them in place.

Case management leaders have an abundance of responsibilities. We are seeing more and more departments with a decrease in the number of leadership support staff for the director (such as manager(s) or supervisors). Just as an RN case manager or a social worker who has high number of patients at the beginning of the shift, and is challenged with prioritizing the functions required for the shift, the leader likewise has to prioritize his or her responsibilities. Unfortunately, the leader often has to assume the staff is following the compliance requirements.

Even when metrics are present on a dashboard, we often see no one reviewing them, and consequently, no one establishing improvement for metrics not at their expected level.

With the leader not able to monitor each of the required rules and regulations, the leader truly does not know what he or she doesn’t know. We want the leader to be completely aware of their staff’s ability to meet these compliance standards.

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Refund Policy

Our refund policy is governed by individual products and services refund policy mentioned against each of offerings. However in absence of specific refund policy of an offering below refund policy will be effective.
Registrants may cancel up to two working days prior to the course start date and will receive a letter of credit to be used towards a future course up to one year from date of issuance. ComplianceOnline would process/provide refund if the Live Webinar has been cancelled. The attendee could choose between the recorded version of the webinar or refund for any cancelled webinar. Refunds will not be given to participants who do not show up for the webinar. On-Demand Recordings can be requested in exchange. Webinar may be cancelled due to lack of enrolment or unavoidable factors. Registrants will be notified 24hours in advance if a cancellation occurs. Substitutions can happen any time. On-Demand Recording purchases will not be refunded as it is available for immediate streaming. However if you are not able to view the webinar or you have any concern about the content of the webinar please contact us at below email or by call mentioning your feedback for resolution of the matter. We respect feedback/opinions of our customers which enables us to improve our products and services. To contact us please email [email protected] call +1-888-717-2436 (Toll Free).




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