Healthcare case management can mean very different things to your healthcare organization, compared to any other. In general terms, the middle of the revenue cycle takes on the case management load. A good case management team will assist with complex patient care needs, improve patient outcomes, and reduce claim denials for the organization. The definition encompasses a range of functions in support of your patient’s health and human service needs. It could mean something as simple as organizing a group of service providers.
What Is Healthcare Case Management?
Healthcare case management is sometimes called care coordination. It’s the process whereby your organization takes a collaborative approach to assess and manage the best healthcare options for your patients. With an individualized care approach, you can help your patients meet their health and wellness goals.
Align Healthcare Case Management With Revenue Cycle
With the growing need for case management services in healthcare organizations, there are several factors that contribute to your success. As you work toward improving your case management services, TempDev can help you align those services with your revenue cycle management.
In the initial meeting between the case manager and the patient, your goal is to gather as much information as possible about the patient’s demographics, insurance, medical history, and whether your services will be a good fit for their needs. With the healthcare case management process, you may find that your services are not a match, in which case, you might refer them to another resource or provider.
This initial meeting can take the place of the registration portion of your revenue cycle, or it can take place right after the registration process. Here again, your goal is to gather the patient’s key details so you’ll have the information you need to process the claim with the patient’s insurance provider.
During the assessment, a case manager will dig deeper into the patient’s needs, with the purpose of determining exactly where the patient is experiencing problems and challenges, as well as what their goals are.
With rapidly changing reimbursement models, this assessment process can also involve forms, resources, and tools that fall outside the standard purview of the case manager. These additional assessment services will need to be processed as part of your revenue cycle management process, but TempDev can help you with that.
Once you’ve discussed specific challenges and goals, you move on to planning, where you will focus on specific goals and actions that will facilitate achieving those goals. It’s part of a process where you’ll focus on the actions that will help each patient achieve their desired outcomes. As with any plan, the goals should each be measurable within the realm of possibilities.
During this planning process, you’ll need to keep your patient’s records clear, concise, and organized. These details will probably also become a part of your revenue cycle in healthcare. You’ll need to seek pre-authorizations, but also make sure you and the patient understand what is covered by their insurance provider.
The next step in the healthcare care management process is typically for you to monitor the progress of your patient, tracking their progress via the results that you’ve already discussed and laid out in the case management plan. These monitoring scenarios are increasingly digital as remote patient monitoring becomes more popular.
The monitoring process also entails reports and discussions about progress and challenges. You can include the forms and reports as part of the patient’s electronic health record (EHR), as well as an element that can be incorporated as part of your revenue cycle for billing, particularly as you're able to gather the data you need.
Part of the case management also involves evaluation, where you determine when and how the patient achieved measurable success, based on the goals that were established. The evaluation process might also be ongoing, with new goals determined. After all, case management can also be a process that’s ongoing as your patient continues to achieve measurable goals.
In every phase of the evaluation process, keep your billing team in the loop, so they’ll have a better idea of what pre-authorizations will need to be sent as well as what claims they will need to process as part of your revenue cycle management.
How TempDev Can Help With Your Healthcare Case Management Needs
TempDev’s revenue cycle consultants support you with how to align your case management with your revenue cycle. So, if you’re struggling with bad debt, credit balances, denied claims, or other recycle cycle issues, TempDev can help with case management issues, concerns, or even billing issues.
With Revenue Cycle Optimization, Flat Rate Billers, and Practice Management Assessment, we focus on identifying your unique medical billing challenges, so we can deliver the targeted solutions you need the most. We offer the tools and resources you need, with top tips and tricks that will not only make your medical processes easier and more efficient, but they’ll also help to ensure your success.
Contact us here or by calling us at 888.TEMP.DEV to get the help you need with revenue cycle management.
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