The Hospital Case Management Orientation Manual

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The Hospital Case Management Orientation Manual

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The Hospital Case Management Orientation Manual

Peggy Rossi, BSN, MPA, CCM

Reviewed by Karen Zander RN, MS, CMAC, FAAN

The Hospital Case Management Orientation is a comprehensive resource that supplements initial training for new case managers. This book explains what to document, where to document it to ensure appropriate level of care and reimbursement, and how to avoid unnecessary denials.

This book’s focus is utilization management, discharge planning, and relevant CMS regulations. It can help new case managers learn how to perform their jobs effectively on their own time. It can also serve as a wide-ranging resource for more experienced case managers, particularly those whose training was less than adequate.

Table of Contents

Chapter 1: Case Management Basics
Chapter 2: Factors Influencing Case Management and Its Processes
Chapter 3: Healthcare Funding
Chapter 4: Utilization Review and Utilization Management
Chapter 5: Letters, Denials, and Appeals
Chapter 6: Care Coordination
Chapter 7: Transfers, Levels of Care, and Transition Planning
Chapter 8: Home Health, Hospice, and Other Home Care Services

Who should read this book?

  • Case manager
  • Director of case management
  • Clinical documentation specialist
  • Director of clinical documentation improvement
  • Chief financial officer

About the Author

Peggy Rossi, BSN, MPA, CCM, has more than 50 years of nursing experience, much of it in case management, utilization management, and discharge planning. Rossi is a consultant at The Center for Case Management in Wellesley, Mass., where she provides hospital case management consulting services to ensure clients' compliance with state and federal law and to ensure accurate reimbursement.

About the Reviewer

Karen Zander RN, MS, CMAC, FAAN, president and chief executive officer of The Center for Case Management in Wellesley, Mass., has more than 40 years of healthcare experience. In this role, she serves as a consultant and educator to hospitals, physicians, healthcare systems, and software, pharmaceutical, and consulting companies worldwide for the development of tools, roles, and systems to support provider-side control of cost and quality.

Published: June 2014