Case Management
Customers, payers, providers, employers and regulators demand value, quality, accountability and cost efficiency in healthcare services. We meet them with effective strategies that bridge the gap between cost and quality. Case Management is one of the most effective ways 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 essential. This coveted designation enables hospitals and healthcare organizations to attract quality physicians, staff, payers and patients. Organizations must be in compliance with JCAHO guidelines and have a proven track record prior to completing a series of challenging surveys.
PYA assists numerous providers and payers in multiple areas related to case management processes and organizations in meeting JCAHO standards. We offer an array of customized services to meet 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
Survey Preparation Services:
- 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 worked with clients on a variety of case management and survey preparation projects. Representative samples follow:
- PYA assesses registration processes for improvement in the collection, documentation and utilization of patient information necessary to reduce billing errors.
- PYA conducts Observation Bed utilization analyses and educational services that gave clients the tools to document appropriate patient status and comply with regulatory requirements.
- PYA assists health systems with the changes necessary that comply with federal and other payer utilization management requirements. These initiatives include assessment of medical records, education for physicians on documentation requirements, and development of policies and procedures to improve compliance.
- PYA assists with standardization of Case Management processes that improved efficiency and productivity and result in reduced re-work and improved compliance with standards of care.
- PYA serves as a resource for clients in assessment of payer requirements, denial of payment letters and payer repayment requests.
- PYA provides initial readiness assessments and assisted clients develop action plans to meet JCAHO standards. Assessments include reviews of policies and required procedures, clinical and patient services and documentation.
- PYA guides hospitals and healthcare organizations through development, documentation and determination of outcomes measures that illustrate compliance with JCAHO standards.
- PYA offers 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.