Case Management

Customers, payers, providers, employers, and regulators are demanding a method to determine value, quality, accountability and cost efficiency in the provision of health care services. To meet these demands, organizations must develop effective strategies to bridge the gap between cost and quality. Case Management has been recognized as one of the most effective strategies to increase and maintain cost efficiency while improving patient care and satisfaction.

In the competitive healthcare industry, accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is also essential. This coveted designation enables hospitals and healthcare organizations to attract quality physicians, staff, payers, and patients. In order to pass these challenging surveys, organizations must be in compliance and have a proven track record prior to survey.

At PYA, our team members have assisted numerous providers and payers in multiple areas related to case management processes and organizations in meeting JCAHO standards. We offer a wide array of customized services to meet our clients’ needs related to care management and survey preparation.

Case Management Services:

• Pre-admission & Registration Process Reviews
• Observation Bed and Denials Management
• Assessments and Program Development
• Utilization Management & Case Management Assessments and Program Development

• Comprehensive Survey Readiness Assessments
• Performance Improvement/Quality Improvement
• Program Consultation and Training
• Regulatory Reviews
• Staff Preparation for Surveyor Questions
• Medical Staff/Leadership Compliance with JCAHO
• Medical Record Focused Reviews
• General and Customized Education & Presentations

• PYA has provided assessments of registration processes that identified areas for improvement in the collection, documentation, and utilization of patient information necessary to reduce billing errors.
• PYA has conducted Observation Bed utilization analyses and educational services that provided our clients with tools to address issues surrounding the process of assigning and documenting appropriate patient status in order to comply with regulatory requirements.
• PYA has assisted health systems with internal changes necessary to meet and comply with federal and other payer utilization management requirements. These initiatives include medical records assessments, education of documentation requirements for physicians, and development of policies and procedures to improve compliance.
• PYA has assisted in the standardization of Case Management processes that improved efficiency and productivity, resulting in reduced re-work and improved compliance with standards of care.
• PYA has served as a resource for clients in the assessment of payer requirements, denial of payment letters, and payer repayment requests.
• PYA has provided initial readiness assessments and assisted clients in developing action plans to meet JCAHO standards. Assessments include reviews of policies and required procedures, clinical and patient services, and documentation.
• PYA has guided hospital organizations in the development, documentation and determination of outcomes measures that illustrate compliance with JCAHO standards.
• PYA has furnished educational sessions that improved staff confidence during the survey process

Services Offered:

• Pre-admission & Registration Process Reviews
• Observation Bed and Denials Management
• Assessments and Program Development
• Utilization Management & Case Management Assessments and Program Development