Utilization Management: Meeting Challenges in a Value-Based Reimbursement Environment

Presented By Toni Cesta, Ph.D., RN, FAAN & Beverly Cunningham, MS, RN

Provided by Relias Learning, LLC

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Release date: May 3, 2017

Valid through: May 3, 2018

Topic: CMS

Estimated Time to Complete Activity: 90 minutes

Target Audience

Anyone involved with or interested in case management, including but not limited to: CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Department Directors, Quality Improvement Staff, Physicians, Nurses (all levels), Compliance Officers, Behavioral Health Staff, Social Workers, Discharge Planners, Case Managers, Hospice Staff and Regulatory Affairs Staff.

Program Overview

This program will focus on the role of UM in a value-based reimbursement environment, and review UM in today’s contemporary case management models. Our experts will discuss best-practices for your work when providing the UM process in a hybrid environment, like UM for bundled payment patients versus the traditional commercial patient. Attendees will also be provided with tips and strategies for streamlining the UM process.

Learning Objectives

After this presentation attendees will be able to: 

  1. Describe the utilization management process to ensure payment in value-based reimbursement.
  2. Identify ways in which the utilization management process can improve reimbursement when there is no denial process.
  3. Discuss utilization management in contemporary case management models.

Accreditation

Relias Learning, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Credit Designation

This program has been approved by the Commission for Case Manager Certification for 1.5 clock hour(s).

This activity has been approved for 1.5 nursing contact hour(s) using a 60-minute contact hour.

Provider approved by the California Board of Registered Nursing, Provider # CEP13791 for 1.5 Contact Hour(s).

This activity is valid May 3, 2017 through May 3, 2018.

Faculties

Toni Cesta

 

Toni Cesta, PhD, RN, FAAN is a founding partner of Case Management Concepts, LLC. Dr. Cesta is the author of eight books, a frequently sought-after speaker, lecturer and consultant and is considered one of the primary thought leaders in the field of Case Management. Dr. Cesta also writes a monthly column called Case Management Insider in AHC Media’s Hospital Case Management newsletter. She has been active in the research and development of Case Management for over 20 years.

 

Beverly Cunningham
Beverly Cunningham, MS, RN 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 also is the former Vice President of Resource Management at Medical City Dallas Hospital.

 

 

Financial Disclosure

It is the policy of Relias Learning that all faculty participating in continuing education activities disclose to the audience in advance of the activity any consultant, stockholder, speakers’ bureau, research, or other financial relationships with companies having ties to this field of study. We disclose that Toni Cesta and Bev Cunningham are consultants for Case Management Concepts. Lead Nurse Planner Amy Johnson reports no relevant financial relationships related to the material presented in this webinar.

Nonā€endorsement of Products

Mention of products or services in this webinar does not constitute endorsement. Clinical, legal, tax, and other comments are offered for general guidance only; professional counsel should be sought for specific situations.

Instructions for Participation and Credit

During the accredited period, participants must read the learning objectives and faculty disclosures; study the educational activity; and complete the evaluation form. If you complete the evaluation, your certificate will be available immediately for download in PDF format.

Hardware and Software Requirements

Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. You will need a PDF viewer such as Adobe Reader to view PDF files.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.