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A physician must concur with the decision
and document this with an observation order
in the medical record.
Thechangeismadebeforethepatient
is discharged and no claim has been
submitted.
The patient should be informed.
For example, if our asthmatic patient had been
admitted to the hospital as an inpatient, and several hours later on utilization review (UR) had
been found to not meet inpatient criteria, the case
manager would have brought the issue to the UR
committee for their review and input. If UR
agreed that outpatient services would be more
appropriate, the admitting physician would be
queried and if she or he concurred an order would
be written for placing the patient in observation.
Other criteria noted earlier would need to be met
and condition code 44 would be added to the
outpatient claim form prior to billing.
If all of the above conditions are satisfied, an
outpatient, rather than an inpatient, claim is submitted with condition code 44 reported in one of
the form locators in fields 24–30 on the UB-04
claim form.
8
If this condition code 44 situation does occur
it is important to remember that the counting of
observation hours starts only after the observation
order is written. The charges incurred before this
conversion may be reported under revenue code
760 or 761.
Other implications of utilizing observation
rather than inpatient status include a higher outof-pocket cost for the patient as they will incur copays for outpatient services and the potential loss
of a three-day qualifying inpatient stay for skillednursing facility coverage. For example, as an inpatient our asthmatic might have had nearly full
coverage. However when classified as observation
the patient is now responsible for their outpatient
deductible and any co-insurance.
Back-end billing processes related to observation reimbursement include the posting of
payments, monitoring, and follow-up on denied
claims. Not all payers document their policies
and sometimes denials occur for unan ticipated
reasons. It is important that someone monitors
payer notification statements to ensure billed
charges are reimbursed appropriately.
Facility Observation Reimbursement
After a payer receives the hospital’s electronically
submitted claim for observation payment, it will
be processed or adjudicated and, if all requirements are met, a payment will be issued.
Medicare uses a software claims editor, called
the Integrated Outpatient Code Editor (I/OCE),
which will determine if observation payment criteria are met and the claim should be paid. In
this way, coders do not have to determine if an
observation case meets specific criteria in order to
code it, the software does this for them. The I/OCE
reviewsthesubmittedclaimanddetermines
the appropriate reimbursement based on the OPPS
rules and the specific Ambulatory Payment Classification (APC) that the submitted CPT and HCPCS
codes map to (APCs are the outpatient counterpart
to inpatient diagnosis-related groups [DRGs], and
each has a designated payment rate).
CMS has designated observation services as a
Comprehensive APC or C-APC. They are called
comprehensive APCs because observation and the
ED or clinic visit or direct referral that preceded
it, as well as the vast majority of ancillary studies
and treatments, are not reimbursed separately but
rather in a single payment for the combination of
these multiple services. For example, our asthmatic
patient received a 99285 ED service, followed by
8 hours of observation. (Table 63.3) On the UB
04 the facility would report 99285 and 8 units of
G0378. The Medicare I/OCE converts those two
codes to C-APC 8011, resulting in a single payment for both services to the hospital. Additionally,
as a Comprehensive APC the nebulizer treatments
as well as typical X-rays and other medications are
packaged into the single payment (Table 63.4).
Payment methods for observation vary greatly
by payer; the payment may be prospective, such
as under Medicare’s OPPS rules, hourly, tiered
based on blocks of hours, or a case rate. The
approximate payment for Medicare observation
is $2174 for C-APC 8011.
So, for our asthmatic patient who was initially
charged as a 99285 ED visit with reimbursement
of $486, with the addition of the 10 units/hours of
G0378 the patient now is categorized as Observation, which moves the visit to C-APC 8011 and
reimbursement of $2174, representing a roughly
$1800 increase.
Hospital Coding and Reimbursement
068
21:24:12
If observation criteria are not met, the hos-
pital’s payment will be based on the service that
preceded it – an ED or clinic visit or a direct
referral (reported with HCPCS code, G0379).
Most, but not all, commercial payers now
recognize and reimburse hospitals for medically
necessary observation care. If observation payment policy information is not addressed in the
hospital’s contract with the payer, the information
may be located on the payer’s website or in a
policy manual. If not found, it will be important
for someone at the hospital to query the payer to
determine if the observation service is reimbursed
and if so, exactly how the payer expects it to be
reported. As with all services, it is wise to review
payment statements to watch for denials: if all
observation paymen t rules and criteria were met
the denial should be appealed.
Compliance Oversight for
Observation Services
Recovery Audit Contractors (RACs) and other
Medicare contractors, and even private payers,
are intensely scrutinizing one-day inpatient stays
and use of observation services. Observation has
also been identified as an issue of concern in
the Office of Inspector General’s (OIG’s) annual
work-plan. For these reasons, and because it is a
best practice, hospitals should have written policies and procedures addressing the clinical and
revenue cycle aspects of observation services.
These policies should address observation
eligibility criteria, medical necessity, and known
observation risk areas – physician orders, documentation requirements, physician presence,
observation timing issues, standing orders for
observation, and excessive lengths of observation over 48 hours. Policies should be based
on, and consistent with, internal hospital policies, joint commission standards, state licensure
requirements, as well as the Medicare and
Medicaid guidelines applicable to the hospital’s
geographic area.
Observation should be one of the areas monitored under the hospitals compliance plan. Periodic reviews of policies and audits of observation
encounters will help identify concerns and opportunities for improvement, and also demonstrate
the hospital’s commitment to compliance. It is
important that someone at the hospital monitors
regulatory changes and updates as applicable to
observation. This would include CMS’s OPPS
rules; Medicare Transmittals related to observation; commercial payer, Medicare, and Medicaid
website; and commercial payer bulletins. If relevant information is identified it should be communicated internally, added to policies and
procedures, and applied to observation revenue
cycle practices.
Table 63.3 Typical Medicare Facility Reimbursement Rates
Code APC Reimbursement
99284 5024 $326.99
99285 5025 $486.04
99291 5041 $666.27
G0463 5012 $102.12
$
Source: 2016 OPPS Final Rule
Table 63.4 Medicare Observation Comprehensive APC and Reimbursement
Observation APC and
Descriptor
Criteria for Medicare Observation Reimbursement Reimbursement
C-APC 8011 –
Comprehensive
Observation Services
Requires at least 8 units of HCPCS code G0378 in addition to
99281–99285, 99291, G0380–G0384, or G0463 on the same
day or the day prior.
$2174.14
Source: Medicare Claims Processing Manual; Observation Services
Candace E. Shaeffer and Michael A. Granovsky
068
21:24:12
References
1. How Nurses Can Impact the
Revenue Cycle. HFMA–The
Business of Caring, pp.12–13,
August, 2007.
2. www.cms.gov/Medicare/
Medicare-Fee-for-ServicePayment/
HospitalOutpatientPPS/
Downloads/HospitalOutpatient-TherapeuticServices.pdf (Accessed
February 19, 2016)
3. Federal Register, 42 CFR,
CMS-1633-FC; CMS Vol. 80,
No. 219 November 13,
2015, OPPS Final Rule CY
2016, pp.
4. Medicare Claims Processing
Manual 100-04, Chapter 4,
Section 290.1 – Observation
Services Overview, December
18, 2015 .
5. Medicare Claims Processing
Manual 100-04, Chapter 4,
Section 290.4.3 – Separate
andPackagedPayment
for Observation
Services, December 18,
2015.
6. Medicare Claims Processing
Manual 100-04, Transmittal
1760, Section 290.2.2, July 6,
2009.
7. Medicare Claims Processing
Manual 100-04, Chapter 4,
Section 290.2.2 – Reporting
Hours of Observation,
December 18, 2015.
8. Medicare Claims Processing
Manual 100-04, Chapter 1,
Section 50.3.2 – Policy and
Billing Instructions for
Condition Code 44, May 8,
2015.
Hospital Coding and Reimbursement
068
21:24:12
Subpart VB
Chapter
64
Financial – Case Management
Determining the Correct Status
BK Kizziar, RN-BC, CCM
Consider the various portals through which
patients may enter an acute care hospital. The
most common and best known is the Emergency
Department. There are also direct admissions
from commu nity physician offices. Patients may
also be transferred from a lower-level facility to
the hospital. Or a hospital-to-hospital transfer
may occur. Each of these portals are critical areas
for identifying if the patient actually requires an
inpatient hospitalization level of care. Often, the
admitting physician does not have sufficient clinical information to make the final judgment.
However, it may be obvious that the patient does
require some level of medical care and further
information is required in order to make the
determination as to what level of care that might
be. In acute care hospitals there are two categories
for patients entering through these portals: Inpa-
tient and Observation.
Inpatient status is given to a patient who
requires constant clinical monitoring by licensed
professional staff including physicians, nursing,
and other care providers. Most hospitals utilize a
standardized set of criter ia that was developed to
assist in the determination of a level of care. The
criteria, available from several commercial companies, consists of objective clinical findings and
treatments appropriate with the condition and
diagnosis. The admission criteria are commonly
known as Severity of Illness (SI) and includes all of
the appropriate levels of care for the condition.
During the physician’s evaluation of a patient to
determine level of care several initial criteria are
considered. The criteria are set forth by the
Centers for Medicare and Medicaid Services
(CMS) and include:
1–3
1. The severity of the signs and symptoms
exhibited by the patient,
2. The medical predictability of something
adverse happening to the patient,
3. The need for diagnostic studies, acute care
level monitoring, medical management, etc.,
4. All available treatment settings and options.
Should a patient not meet the initial screening
criteria for an inpatient status but continue s to
require a significant level of clinical monitoring,
the patient may be placed in an Observation
status.
Observation is an outpatient designation in
which services are provided including the use of
a bed, at least periodic monitoring by nursing and
other staff, and necessary treatments that are reasonable and necessary to evaluate and treat the
patient’s condition or determine the need for an
inpatient designation and stay. Observation care
is rendered in the hospital although classified as
outpatient services. It is intended for short-term
monitoring, generally less than 48 hours for
Medicare patients and 23 hours for managed
care patients.
This chapter will speak specifically to Medi-
care reimbursement criteria as managed co mpanies negotiate various reimbursement systems
with their contracting providers. Documentation
by the physician is critical in establishing this level
of classification. A physician’s order must specify
“Observation Status” and must be signed and
dated by the admitting physician. When the
patient has been in Observation Status for 23
hours, physician documentation in the progress
notes must include the need to continue observation with a plan for discharge within the next
12–24 hours or the need to convert the patient
to an Inpatient Status, documenting the medical
necessity for admission or the medical stability of
the patient allowing for discharge and a plan for
follow-up services a indicated.
“Observation” is a payment category and not
an indication of the level of services a patient
requires. Should the hospital determine after
069
21:24:44
admission that the patient did not require an
acute level of care there are two options for correcting the status of Medicare beneficiaries. One is
known as a “Condition Code 44.”
4
The other is
“Provider Liable.”
Transmittal 299 Change Request 3444 (Condi-
tion Code 44) allows the hospital to change a
patient status from Inpatient to Observation provided that four criteria are met:
1. The change in patient status from Inpatient to
Outpatient/Observation is made prior to
discharge or release while the individual is still
a patient of the hospital;
2. The hospital has not submitte d a claim to
CMS for any of the time the patient has spent
receiving hospital services;
3. A physician concurs with the utilization
review committee’s decision; and
4. The physician’s concurrence with the
utilization review committee’s decision is
documented in the patient’s medical records.
The entire episode of care should be treated as
though an inpatient admission never took place
and should be billed as an outpatient episode of care.
Provider Liable is submitted on a UB-04 claim
form indicating the provider is liable for the
inpatient admission if the determination that the
patient did not meet acute level of care criteria is
made after the discharge of the patient.
When a hospital determines that a Medicare
beneficiary does not need to be admitted or no
longer requires inpatient care, the hospital must
notify the beneficiary of this determination. The
notification is called a Hospital Issue Notice of
Non-Coverage (HINN) or a Medicare Advantage
Notice of Discharge and Medicare Appeal Rights
(NODMAR). If the beneficiary chooses to be
admitted or remain in the hospital following this
notification, the hospital may charge the beneficiary, rather than Medicare, for the stay. Only the
continued stay HINN must be reviewed by the
Medicare fiduciary prior to delivery to the patient.
An Advance Beneficiary Notice (ABN) is given
to a Medicare beneficiary when it is anticipated
that the outpatient/observation treatment, care, or
services will not be covered by Medicare. The
patient must make the decision to forego the
intervention or to assume financial responsibility
for the cost. This situation is seen typically in the
Emergency Department. A patient presents with a
condition that does not meet either Inpatient or
Observation criteria. However, the patient desires
to be admitted and the physician is willing to
admit the patient. The patient must be made
aware that Medicare will not fund the admission
and should the patient be admitted will be
expected to pay for all hospital services. If the
patient is in Observation status and the physician
wishes to change the status to Inpatient although
the patient does not meet inpatient criteria, a
Pre-Admission Advanced Beneficiary Notice
(PAABN) must be issued to the patient indicating
that the patient will be financially responsible for
Table 64.1 Beneficiary Notices
Type of Notice Attending or QIO*
Concurrence
Patient Liability Begins
Preadmission or
Admission HINN
No Point at which patient enters hospital after receipt of notice is
received. However, to hold a patient liable for charges on the day of
admission, the notice must be issued no later than 3 p.m. on the
day of admission. If the notice is issued after 3 p.m. the patient is
liable beginning the following day.
Hospital
requested review
Yes Notification that patient does not qualify for continued stay but the
physician disagrees and wishes the patient to remain in the hospital.
The HRR notifies the patient that the hospital is asking the QIO to
review the case and make a determination whether the patient
meets clinical criteria to remain in the hospital.
HINN-11 Yes Noncovered service during covered stay.
HINN-12 Yes Noncovered continued stay. Includes statement from Business
Office estimating the cost to the patient of a continued stay.
* QIO quality improvement organization
Determining the Correct Status
069
21:24:44
all hospital services. In all instances of ABN/
PAABN issuances, the patient signature on the
form is not required. There must, however, be
evidence that the patient was informed as verified
by witness signatures on the ABN forms. Claims
are submitted with an indication that an ABN was
given. (See Table 64.1.)
Medicare has contracted with private auditing
firms to review discharged files to determine if
patients are classified incorrectly. These auditors,
known as Recovery Audit Contractors (RAC), review
randomly selected discharged charts. Admissions
determined to have been inappropriately classified
as Inpatient are charged the amount that was paid
by Medicare for the inpatient claim. Hospitals may
also be fined for continued misclassification. The
RACs are reimbursed for their services through a
contingency agreement in which they receive a portion of the monies recouped.
Medicare Administrative Contractors (MACs)
were put into place to consolidate Medicare Part
A and Part B claims processing. The MACs will
also compare hospital and physician claims to
ensure continuity in billing practices.
The quality of care and treatment of the
patient should be the same whether the admission
is classified as Inpatient or Observation. The difference is strictly a cost issue. This is an important
consideration for patients, hospitals and payers.
When admitted under Observation the patient
becomes financially responsible for the co-pays
associated with their payer requirements. The
exact amount varies with the service provided
and the payer benefits. Patients may be responsible for more than one co-payment. If the
patient’s needs are best met in the acute care
setting as an Inpatient, the co-pay req uirement
may be significantly different and deductibles will
play a role. However, if after discharge from an
acute care inpatient stay the admission was
deemed inappropriate, the hospital could be
responsible for the entire cost of the stay.
References
1. Centers for Medicaid and
Medicare Services (CMS)
https://www.cms.gov/
Regulations-and-Guidance/
Guidance/Transmittals/
downloads/R1374CP.pdf
(Accessed April 2016)
2. Hospital Inpatient Admission
Order and Certification https://
www.cms.gov/Medicare/
Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/
Downloads/IP-Certificationand-Order-09-05-13.pdf
(Accessed April 2016)
3. Final Comments for Acute
Inpatient Services versus
Observation (Outpatient)
Services (Hosp-001) DL322.
https://downloads.cms.gov/
medicare-coverage-database/
lcd_attachments/32222_1/
DL32222_HOSP001_Final
Comments.pdfA (Accessed
April 2016)
4. Clarification of Medicare
Payment Policy When
Inpatient Admission is
Determined Not to be
Medically Necessary, Including
the Use of Condition Code 44:
“Inpatient Admission Changed
to Outpatient”Transmittal #:
R299CP https://www.cms.gov/
Outreach-and-Education/
Medicare-Learning-NetworkMLN/MLNMattersArticles/
downloads/SE0622.pdf
(Accessed April 2016)
BK Kizziar
069
21:24:44
Subpart VB
Chapter
65
Financial – Case Management
Case Management: Care Coordination
Nancy E. Skinner, RN-BC, CCM
Observational Status: Care
Coordination Through Each
Transition of Care
When establishment of the medical necessity and
appropriateness of care based on intensity of services and severity of illness fails to meet criteria
for admission to an acute care facility, medical
management and the consistent monitoring of the
patient’s health status may be provided as an
outpatient service. Deemed observational status,
these services are generally utilized to gain additional information regarding the acuity, significance, and/or potential impact of presenting
symptoms or to provide continued care or interventions during a prolonged recovery following
an outpatient procedure.
1
Any decision regarding appropriate patient
status is based on established criteria, supported
by specific and documented clinical rationale, and
follows a signed and dated physician order. Determinations regarding the appropriateness of inpatient admission or observational status must be
consistent with that physician order, the medical
interventions or management to be provided, and
the established medical necessity and appropriateness of those services.
Although the hospital utilization review committee and utilization management plan is defined
in the hospital Condition of Participation (CoP),
the process of adhering to that Plan and following
the criteria that supports that Plan is a vital function of the hospital case manager or utilization
manager. These health care professionals (HCP)
are charged with coordination of each step within
the process in order to facilitate effective utilization
review and advance appropriate reimbursement
for provided services. This is a role that should
not be considered to be intermittent or cursory.
To be successful, utilization managers should be
available within most facilities at least 16 hours
each day, every day of the year.
Although observational status is billed as an
outpatient service, the quality of provided care is
mandated to be the same whether the patient is
admitted to the acute care facility or determined
to be appropriate for outpatient observation.
In March 2011, the U.S. Department of Health
and Human Services released its National Strategy
for Quality Improvement in Health Care
(National Quality Strategy). The strategy presents
three aims for the health care system:
Better Care: Improve the overall quality, by
making health care more patient-centered,
reliable, accessible, and safe.
Healthy People and Communities: Improve
the health of the U.S. population by
supporting proven interventions to address
behavioral, social, and environmental
determinants of health in addition to
delivering higher-quality care.
Affordable Care: Reduce the cost of quality
health care for individuals, families,
employers, and government.
2
The six priorities identified to support these
aims include:
Making care safer by reducing harm caused in
the delivery of care.
Ensuring that each person and family are
engaged as partners in their care.
Promoting effective communication and
coordination of care.
Supporting better health in communities.
Prevention and treatment of the leading
causes of mortality.
Making quality care more affordable for
individuals, families, employers, and
governments by developing and spreading
new health care delivery models.
3
070
21:30:26
As today’s health care facilities and providers look
to following these strategies and to provide care that
is “safe, timely, effective, efficient, equitable and
patient-centered,” the focus on quality of care, cost
of provided services and patient satisfaction has
never been higher.
4
To achieve this delicate balance,
many hospitals have established specific protocols
that are designed to address the efficient movement
of patients to an appropriate level of care. These
steps include a focus on gaining physician direction
regardingthe appropriate level of patient care based
on a comprehensive assessment of the patient’s
history and physical exam, any risk factors that are
present or probable due to the patient’scondition,
and the care required to address patient-specific
continuing needs. Additionally, the physician must
document the order to provide observational care
and confirmation that similar criteria is utilized for
all patients regardless of payer.
While each step in the utilization review process is generally well scripted and supported by
established criteria, the process that encourages
patient/family engagement in their care and facilitates an efficient and timely transition to the next
level of care is often fragmented and haphazard.
Patients sometimes move from one environment
or provider to another with little advocacy, no
established transitional care plan, and absolutely
no idea that it should not be that way. We “treat
‘em a nd street ‘em.” We “diagnosis and adios”
and rarely consider affecting an appropriate transition of care. In many instances, this lack of care
continuity may negatively impact the goals we
desire for our patients and the goals our patients
have established for themselves.
To be more successful in facilitating enhanced
patient engagement and promoting effective communication across all levels of care, it is vital that
the role of the case manager is not limited to utilization review. Case management is defined by the
Case Management Society of America (CMSA) as:
Case management is a collaborative process of
assessment, planning, facilitation, and advocacy
for options and services to meet an individual’ s
able resources to promote quality cost-effective
outcomes.
5
To fulfill this role and adhere to the intent
if not the content of this definition, the case
manager is charged with coordination of transitional services as the patient moves to the next
level of care and the next provider of services.
This function is not limited to traditional discharges that occur at the end of inpatient admissions but also includes the coordination of care
as the patient moves from the portal of entry to
observational status and from observation to
following level or site of care.
The multidisciplinary treatment team is
charged with both the provision of care and patient
empowerment, engagement, and education during
any hospital stay or intervention. This includes
every patient who receives observational monitoring and care. Some outpatient environments
employ case managers to provide effective care
coordination. Other hospitals utilize members of
the care delivery team to achieve this role. But, in
every health care setting, care coordination must
be an essential element of the stay and never be an
afterthought or intended intervention that is not
consistently delivered.
Care coordination as defined by the National
Quality Forum (NQF) is a “function that helps
ensure that the patient’s needs and preferences for
health services and information sharing across
people, functions, and sites are met over time.
It maximizes the value of services delivered to
high-quality patient experiences and improved
health care outcomes.”
6
Care coordination typically
encompasses the assessment of the patient’sneeds,
the development and implementation of a plan
of care, and an evaluation of the care plan.
Transitional care, a more targeted form of
care coordination, is a set of actions designed to
advance the coordination and the continuity of
health care services as patients transfer between
different locations or different levels of care within
the same location.
7
In order to deliver efficient and
effective care coordination services, an appropriate
“handover” of the patient to subsequent care providers and care givers is absolutely necessary. The
initial step in this process begins when the patient
enters the acute care facility seeking health care
services and includes the following:
What is the patient’s primary concern
regarding their health status?
Did a member of the team perform a
comprehensive evaluation of past history and
current physical condition?
Nancy E. Skinner
070
21:30:26
What is the name or names of HCP who
provide or provided care to the patient in the
past?
Has a member of the health care team
attempted to reach out to that HCP to gain
further information regarding the patient’s
health status?
Has the patient made any decision regarding
advance directives?
Which medications are currently being
prescribed for the patient? Which medications
have been prescribed in the past?
What medication regimen does the patient
currently follow including over-the-counter
medications?
Does a local pharmacy or pharmacy benefit
manager fill current prescriptions?
What is the patient’ s understanding of their
current diagnosis or diagnoses?
Does the patient possess and maintain a
personal health record?
After a determination is made regarding placement to observational status, who is primarily
responsibility for assuring an appropriate handover of the patient to the HCP that will be managing that patient’s care during an observational
stay? Additionally, the process of patient engagement, empowerment, and education must begin if
it had not already been initiated in the emergency
department or other portal to care. Education
minimally includes information regarding the
diagnosis and what that diagnosis means. It is
vital that all education be provided based on the
patient’s health literacy and cultural beliefs. Subsequent education is generally focused on moving
the patient to self-management of their disease
state and active participation in their plan of care.
As the patient prepares to transition out of
observation to the next level of care, it is vital that
each patient receives the following:
Verbal and written information regarding
their diagnosis and what that diagnosis means.
A copy of the prescribed treatment plan
including a medication list that has been
reconciled.
A list of the potential signs of disease
exacerbation and the steps to take if that
increase in symptoms occurs.
A referral to community-based care
management if those services are available in
the geographic region in which the patient
resides.
An appointment for physician care in the
community.
Although the following measures have not been
implemented for outpatient environments as yet,
the consistently changing and expanding regulations and reimbursement associated with a satisfactory patient experience are expected to touch
outpatient services in the future.
8
To prepare for
that probability, it is recommended that HCPs and
acute care facilities that serve patients in outpatient
settings begin to consider the Key Measures for the
National Quality Strategy Priority.
9
One set of
those measures is detailed in Table 65.2.
Consider who within your current health
care delivery environment advances the patient’s
ability to positively respond to those three key
descriptors. If no one member of the team shoulders that responsibility, it is time to reengineer the
transition of care in order to facilitate the timely
movement of the patient through the health care
continuum. It is my belief that the one member of
the team who is this facilitator is the care coordinator or case manager. Their role must minimally
include a role that reflects the established definition of case management while achieving that
delicate balance of fiscal responsibility and patient
advocacy.
Table 65.2 Key Measures for National Quality Strategy
Priority – Promoting Effective Communication and
Coordination of Care
8
Measure Focus Key Measure Name/
Description
3-item care
transition
measure
During this hospital stay,
staff took my preferences
and those of my family or
caregiver into account in
deciding what my health
care needs would be
when I left
When I left the hospital,
I had a good
understanding of the
things I was responsible
for in managing my
health
When I left the hospital,
I clearly understood the
purpose for taking each of
my medications
Case Management: Care Coordination
070
21:30:26
References
1. Medicare Benefit Policy
Manual, CMS Pub. 100-02,
Chapter 6, §20.6.
2. DHHS. National Strategy for
Quality Improvement in
Health Care. www.healthcare
.gov/center/reports/national
qualitystrategy032011.pdf
March 2011.
3. Ibid.
4. O’Reilly, K. Health Reform
Law Will Boost Care Quality.
Amednews.com. www
.ama-assn.org/amednews
/2010/12/20/prse1221.htm.
June 2012.
5. Case Management Society of
America Standards of Practice
for Case Management, Revised
2010. www.cmsa.org/SOP.
June 2012.
6. National Quality Forum
(NQF) - Endorsed definition
and framework for measuring
care coordination. Available at
www.qualityforum.org/
projects/care_coordination
.aspx. June 2012.
7. Coleman EA, Berenson RA.
Lost in transition: challenges
and opportunities for
improving the quality of
transitional care. Ann Intern
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8. 2012 Annual Progress Report
to Congress – National Strategy
for Quality Improvement in
Health Care. Corrected August
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.ahrq.gov/workingforquality/
nqs/nqs2012annlrpt.pdf. June
2012. (Accessed April 2016)
9. Ibid.
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