Hospital case management : the monthly update on hospital-based care planning and critical paths
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The Centers for Medicare and Medicaid Services (CMS) made significant changes in the final rule for creating accountable care organizations (ACOs) to coordinate care across healthcare settings. CMS made changes in how ACOs will share savings based on input from the industry. ACOs are one way the healthcare field is recognizing the value of care coordination. The number of quality measures on which ACOs report has been reduced from 65 to 33.
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Hospitals will suffer when the Medicaid Recovery Audit Contractor (RAC) starts on Jan. 1, 2012, if case managers aren't scrutinizing those patients as closely as those who are covered by Medicare. Make sure your documentation is complete to avoid denials and prepare for appeals. ⋯ Learn the rules for all states in which your patients reside. Be aware that the Medicaid RACs are charged with taking a proactive approach to identify potential fraud.