Source: CMSA Today By PETER MISKA, RT The healthcare industry has witnessed a substantial transformation with the introduction of value-based payment models, aiming to enhance care quality while controlling costs. Among these, the Patient-Driven Groupings Model (PDGM) stands out as a significant development in home healthcare reimbursement under the Medicare program. Implemented on January 1,

Source: CMSA Today BY PAUL BORJA, RN, MBA, DNP, EdD, PhD, PHN, CCM, ACM-RN, CMAC, CMCN, CNML, CMGT-BC, CDONA, FACDONA, FAACM, AND TERESA CAPINA, RN, MSN Ever wondered if you or your loved ones qualify for skilled nursing facility (SNF) for rehabilitation or skilled nursing services? This article summarizes the requirements and important considerations. The

Source: CMSA Today BY PATRICIA RESNIK, MJ, MBA, FACHE, RRT, CPHQ, CHC, CHPC Introduction Quality, case management (CM) and utilization management (UM) are key to the financial success of a healthcare organization and play a vital role in the revenue cycle. This article focuses on important connections between quality, CM and UM, and the potential

Source: CMSA Today BY LAWANNA GADDY, MSN, RN Quality improvement and accreditation are crucial in the healthcare continuum within a rapidly changing industry landscape. Care management programs and care managers ensure that healthcare delivery is not only effective but also maintains the desired levels of quality every time. This article delves into the essential role

Source: CMSA Today BY VIVIAN GREENWAY, PhD, MSA, BSN, RN, PAHM, CCM, AND SAJINI PAUL, MSN, RN When defining quality management, one can think of it as overseeing all activities and tasks that must be done to support a desired level of excellence. This includes the determination of quality policies, creating and implementing quality planning

Source: CMSA Today BY GARRY CARNEAL, JD, MA, AND MELANIE PRINCE, EdD, MSN, BSN, RN, NE-BC, CCM, FCM, FAAN During the rise of payer-sponsored case management programs in the 1990s, the Case Management Society of America (CMSA) and URAC (Utilization Review Accreditation Commission) began working together to help standardize key workflows associated with case management

Source: CMSA Today By Dr. Colleen Morley-Grabowski, DNP, RN, CCM, CMAC, CMCN, CMGT BC, ACM-RN, IQCI, FCM, FAACM As I transition from my role as president of the Case Management Society of America (CMSA) to becoming the immediate past president and chair of the CMSA Editorial Board, I am filled with a deep sense of