Collaborating for excellent patient care.

Case Management Services

Case Management (CM) is part of the mid-revenue cycle that focuses on appropriate patient status, timely inpatient or outpatient discharge, and discharge arrangements. An effective case management department organizes complex patient care needs, improves patient outcomes, and ultimately reduces denials.

Challenge | Services | Approach | Benefits

Challenge

Case Management (CM) is the combination of clinical information and administrative reporting. The department focuses on the assessment of the patient’s presentation with the payer contract requirements and assigning the patient to the correct level of care. The payer requirements change annually with the contractual terms. The goal is to reduce admission or service denials.

Our Services

RCS can assess all aspects of your departmental operations to identify potential areas of workflow inefficiency. RCS will review and/or establish key performance indicators to monitor departmental effectiveness.

Our Approach

RCS provides experienced consultants to partner with your case management and/or senior management personnel in reviewing operations, determining areas of concern, establishing objectives, and assisting with change management. RCS will:

  • Provide detailed assessment of CM processes
  • Develop benchmarks for key performance indicators
  • Provide management reports on significant findings and opportunities
  • Review payer contracts and provide summary
  • Provide departmental education regarding processes and third-party requirements

Benefits

By partnering with RCS, you will receive a comprehensive work product by highly experienced, credentialed consultants regarding the efficacy of CM processes, admission denials, and suggested changes. Examples of improvements include:

  • Improved patient outcomes
  • Reduced patient denials
  • Improved productivity through review prioritization
  • Customized staff education