Hospital case management : the monthly update on hospital-based care planning and critical paths
-
As payers tighten their belts and recoup payments for inappropriate care and regulators increase penalties for fraud and abuse, hospitals need to ensure all admissions are appropriate and patient are placed in the right level of care. Hospitals are likely to have to return reimbursement for patients who don't meet inpatient criteria. ⋯ Correcting inappropriate admissions retrospectively can be a red flag to auditors. ED case managers can impact length of stay by ensuring that care starts in the emergency department.