A healthcare CRM system can streamline case management processes to improve patient outcomes, reduce payer denials and support revenue cycle and a great Go-To Tool for Case Managers
Being complex and collaborative, case management implies not only care coordination from admission to discharge, but also advocating for options and services to meet patients’ health needs and achieve improved health outcomes.
Handling this process without any dedicated tools or (even) with outdated technology is troublesome, at best. Sometimes, case managers even have to resort to paper to document patient data or draft a care plan. Accordingly, using ineffective and inconvenient technology for case management can cause business problems.
When case management goes wrong
The main pitfall of using inappropriate technology is that case managers don’t have a single system to handle case management plans. This results in poor visibility, segmented and inefficient case plans along with frequent scheduling issues. The diffusion of information between different systems can lead to duplication and data inconsistency across facilities within a healthcare organization, and, accordingly, to the lack of patient case tracking.
Moreover, the system in use may be not tuned to fit all workflows of particular case managers, making them manually handle some part of processes (e.g., invoicing), which is time-consuming and ineffective.
How to fix case management with CRM
Among different technologies capable of supporting case management, we suggest considering implementing a CRM. Hospitals are using healthcare CRM systems in multiple ways, including case management. There are four main reasons for that.
Detailed and expandable patient profiles
A CRM system integrates with the EHR, PMS, and hospital invoicing systems to enable a 360-degree view of a patient’s preferences, care needs, treatment plan, and inquiries. Case managers will have all information required to be on the same page with their patients’ current status (health, services, billing, etc.) and any significant changes.
The hospital CRM, on the one hand, provides case managers with a set of standard tools to organize their workflows and build standardized and trackable processes. On the other hand, it is a human- and management-friendly system, allowing thorough customization and flexibility. Let’s check the possible features:
- Service planning and outcome management
- Patient document management with e-signature for all documents
- Dashboards for case managers and supervisors
- Custom reporting and analytics
With these features, the hospital CRM can help providers to optimize resource-intensive case management processes by deploying technology around patient-centered care. There can be multiple examples, let’s name a few.
For instance, case managers will be able to detect any barriers to care plan fulfillment quickly via custom analytics. Moreover, if some post-discharge services require authorization, it can be requested within the system. The case manager can also create a checklist for patient goals and send them to the patient and the family for discussion during daily reassessments.
We are highlighting the ability to set up automated and configurable alerts for important events because timely notifications are crucial for a smooth case management process. For example, case managers will be aware of any delays or denials in services and can initiate the appeal process or other activities right away.
PHI safety is critical, so the system for case management needs to respond to high demand in patient data protection. Healthcare CRM enables role-based security to comply with HIPAA requirements.
How CRM-driven case management supports revenue cycle and clinical outcomes
Apart from patient outcomes, case management activities across pre-admission, admission, treatment, discharge and post-discharge phases impact the revenue cycle. СRM can assist case managers in yielding positive clinical and financial outcomes. Let’s see a few examples for each phase.
ED screening for admission. Case managers will be able to monitor new admissions within their CRM accounts and make sure that patients are provided with the adequate level of care. In other cases, care services are most likely to be denied by payers.
ED review for relevant patient classification. The CRM allows automatic matching of new patients with the Medicare “inpatient only” list to help the organization avoid delay or denial of payment as well as unneeded staff resource utilization.
Sending clinical reviews to payers for emergent admissions. Case managers can forward the clinical admission reviews required according to contracts with each particular health plan in a more automated way. All applicable forms will be already filled in with available information and offered to the case manager for reviewing, changing and e-signing right in the CRM.
Early discharge planning. Speaking of the revenue cycle, timely discharge planning helps to avoid extended inpatient days and length of stay as well as payer denials. Case managers can use the analytic capabilities of hospital CRM to find similar cases and base their identification of discharge timeline on previous experience.
Care plan implementation and evaluation:
Provide timely care plan reviews. Case managers need to check a patient’s health status and treatment progress, identifying arising barriers and handling them time to ensure a seamless care cycle. CRM has multiple features to support the managers’ efficiency – from step-by-step process flows and checklists (e.g., expected outcomes for the hospital day) to automated alerts.
Reviewing authorized days. To avoid delays in payment, case managers need to reassure that claims submitted for hospital stay have all the days authorized for medical necessity. Since all documents and case plan details are already in the hospital CRM, this process won’t be tedious.
Fulfilling the discharge plan. Incomprehensive discharge plans that don’t incorporate experience-based best practice bear a risk of readmissions. By keeping all case plan parts in one place, case managers can safeguard consistency. Moreover, the organized case plan helps in reducing delays and denials in services, which allows upholding the revenue cycle.
Denial management. The CRM provides case managers with the tools to effectively manage denials, response to post-billing denials and outstanding reviews. Each claim’s status will be tracked, and alerts will notify managers about any issues with case Billings. Moreover, a semi-automated appeal algorithm can be enabled to streamline denial management even further, decrease delays and thus enhance revenue.
Following up with patients. Case managers will be able to communicate with patients via emails or text messages on their post-discharge plans, including home care, treatment details, and durable medical equipment. Be it instructions, self-check lists or surveys, established contact with patients allows to track their health outcomes outside the facility and prevent readmissions.
CRM against the rising caseloads and financial pressure
Case management departments should bridge clinical and financial goals, escaping inadequate care levels, unauthorized days, readmissions, billing delays and payer denials.
CRM can be the system that helps to withstand external financial pressures by reducing internal case management inefficiencies. By allowing case managers to handle daily activities in utilization management, discharge planning, and care coordination within one access point, providers are improving health outcomes and supporting the clinical revenue cycle.
With 5 years of writing on business and technology, Lola is a Healthcare Industry Analyst at ScienceSoft, an IT consulting company headquartered in McKinney, Texas. Being an HIMSS member, she focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Lola’s articles explore chronic disease management, mHealth, healthcare data analytics, value-based care delivery, CMS regulations and more.
If one of your goals for 2017 is to pass the CCM Exam, this is your last chance!
The application window for the August 2017 exam is closed, but the December exam window is now open. You can sign up to take the December CCM exam that will move your career to the next level until September 30, 2017.
Completing your application is easier than ever. The entire application can be done online where you will find everything you need to complete your application.
In order to sit for the CCM exam, you must meet eligibility criteria. Take a look at this post for specific eligibility information.
Qualified applicants will be provided with information via email regarding how to register for the exam and how to make a special accommodations request.
The CCM Exam is an 180-question multiple choice exam which you have 3 hours to complete.
The content of the CCM examination is based on an ongoing, nationwide validation research project. The research has identified five knowledge domains.
- Psychosocial Concepts and Support Systems
- Quality and Outcomes Evaluation and Measurements
- Rehabilitation Concepts and Strategies
- Care Delivery and Reimbursements Methods
- Ethical, Legal and Practice Standards
Additionally, each of the five domains is further defined into sub-domains
Application & Examination Fee
When applying for the exam, I would love it if you would type my name in the “promo code” field found in the Education and License section of the application. This really helps CCMC recognize the work we at The Stay At Home Nurse, LLC are doing to promote case management certification. Doing this will also enter you in a drawing to be held after the application window closes where one lucky CCM and their referred candidate will be randomly chosen by CCMC to each win a $345 American Express Gift Card! Gives you the chance to take the exam for much less! The application fee is $200 and the exam fee is $185, a total of $385 will be paid when you apply.
Qualified applicants can take the exam in over 8,000 locations in 160 countries. Exams are conducted at Prometric Testing Centers, take a look and see where your nearest testing center is.
Now that you’re ready to sign up for the exam, you’ll ask yourself, “How do I study for the exam?”
Take a moment to check out CCM Certification Made Easy which is a test prep book to help you master the knowledge you need to pass. If an online course is a better study option for you, we have the CCM Certification Review Course, which is a 12 module course designed to help you understand the role case managers play in today’s modern complex healthcare systems and how this information is vital to preparing and passing the CCM exam.
You may check out this post for more study tips to help you feel confident and ready to take the exam.
To get more information and to sign up for the exam, head over to CCMCertification.org and click on “Get Certified” or call CCMC Customer Service at 856-380-6836 for assistance.
Remember, if you plan on taking the exam in the month of December, be sure to apply before the September 30th deadline!
Case Management Certification Quick Reference Guide
This is the story of my journey from being afraid
to move beyond the traditional nurse role
to becoming a certified case manager.
We’ve all heard the phrase, “Do What You Love”
An ideal that most of us believe in and want to live by.
I had been a nurse for six years and I loved my job. There’s nothing that brings me more joy than knowing I am making a difference and helping those in need. I prided myself on helping people and the thought of leaving bedside nursing often ended with “I’m afraid I wouldn’t have that same impact on a phone line between myself and a patient.” Still, with the satisfaction of working in the hospital, I was curious and wanted to try something different, something new.
Moving into the case management world of an insurance company is a scary step for someone with the title of Registered Nurse. Passion trumped fear. I took the step and made a choice. I entered the world of Case Management.
A year after settling into the case management role, I can vividly remember how someone told me I was working for the devil. But that did not stop me from doing what I love, rather, I opened my eyes to how case management and the insurance company aren’t the devils and how so much good can come from case management. It made me realize the limitless doors for growth and development that this move had opened for me. My knowledge base grew beyond my specialized NICU nurse role.
Five happy years in the case management world, I realized that even though I loved the position I was in, I felt I wanted more, I needed an edge. The desire for an edge brought me new challenges and experiences.
I took two more steps. One: I changed my position and went to the transplant team, no longer managing a dedicated account and being exposed to more systems and patients with more needs. Second: I decided to obtain my CCM certification. An exam that I found intimidating, but curiosity, determination, and that desire for an edge trumped fear. (more…)
You’re used to taking exams as a professional, and as you know, each test is slightly different. Today, I’d like to go over the layout of the CCM exam and offer specific tips to help you prepare.
When I began studying I didn’t know where to begin. I started by looking at CCMC’s website. They have a lot of valuable information, but it is not easy to find everything you are looking for in one spot. Here is a summary of the information you need to know when preparing for the exam.
CCM Exam Overview
The CCM Exam is administered three times a year in April, August, and December.
The application window opens five months before the exam and remains open for three months.
The CCM exam is administered at Prometric test centers. After being approved by CCMC to sit for the exam you will receive information to contact Prometric to schedule your exam date.
Quick Tip: As soon as you get your authorization from CCMC to sit for the exam, be sure to contact Prometric to get the test date of your choice, as some centers fill up fast!
In order to sit for the CCM exam, you must meet eligibility criteria. Take a look at this post for specific eligibility information.
According to CCMC, “The CCM exam is practice-based, meaning all questions are based on knowledge that an experienced case manager should know and understand. There is not any course or education required to take the exam or to prepare for the exam”.
The CCM Exam includes:
- 180 multiple choice questions (150 are scored, the other 30 are pretest questions that are being tested for possible inclusion of future tests)
- Covers 5 knowledge domains
- Questions are drawn from CCMC item pool
- 3 hours to complete
5 Knowledge Domains
The CCMC Exam questions cover the following five knowledge domains:
Quick Tips for Preparing for The CCM Exam
Here are 8 specific tips for studying and taking the CCM exam:
- The CCM exam was updated in August 2016, make sure you have the updated study materials.
- Plan study time according to the number of questions on the exam. Look at the number of questions in each domain and plan study time accordingly.
- A broad general knowledge is more important than memorizing facts. Have a general knowledge of the items in each domain. Here is a list of the domains.
- Know the Case Manager Philosophy and ensure your answers align with it.
- Study until you understand the information well enough to teach someone about it (especially the information you are not familiar with). When you understand the information that well, it is a good sign!
- Exam questions are direct. There are no “all of the above” or “none of the above,” questions.
- Answer questions according to how Case Managers, in general, would answer, not how it is done at your place of employment.
- Breathe! When you get to the exam, write “BREATHE” at the top of your scratch paper, and look at it when you are feeling overwhelmed.
Hopefully, this helps you have an idea of what to expect on the exam.
If you are looking for study materials, the CCM Study Guide along with the Online Study Course is sure to help you feel confident and ready to take the exam.
I also offer a webinar on Study Strategies for the CCM and Test Taking Strategies for the CCM. To be notified of the next session and to receive more valuable information to help you pass the CCM Exam, click on the blue tab to sign up for my email updates.
Over the last few weeks, we’ve been talking about how amazing becoming a certified case manager is. We’ve gone over how your career will grow, your earnings will increase, and how more employment opportunities await certified case managers. We’ve even talked about the great conferences to attend!
So, you’ve been reading about case management and have decided it is a career move you’d love to pursue. Let’s go over the details of eligibility.
Are You Eligible?
As our world continues to change, the demand for patient-centered healthcare is increasing rapidly. As a result, the need for professional case managers has grown substantially.
The Commission for Case Manager Certification has heeded this need by changing the eligibility criteria for case managers seeking board certification. These changes give much better – qualified professionals the opportunity to take their career to the next level.
According to the CCM Certification Guide, there are 3 areas of qualification applicants must meet to be eligible to take the exam.
- Meet the specific licensure or education requirements.
- Qualify within one of CCMC’s employment category experience categories.
- Be of good moral character, consistent with the CCMC Code of Professional Conduct.
Are you currently working as a case manager?
Are you making $75,000 or more a year?
The CCM recently released a new survey which reveals some fascinating facts about the growth of Certified Case Managers. As the healthcare world continues to become harder to navigate, the need for qualified case managers is growing rapidly.
As the survey points out, since the Affordable Care Act has become law, the number of case managers holding the CCM credential has risen from around 20,000 to more than 42,000. This is good news for the patients who rely on well-educated, dependable care coordinators to help guide them, and the hard working case managers themselves. Becoming a certified case manager is a win, win for all involved.
Here are just a few reasons to take that next step and become certified.
Increased Earning Potential
According to the latest CCM survey, released at the end of March 2017, the median average salary for Certified Case Managers is between $75,000 – $80,000 a year, well above the average RN or Social Worker salary. Even more interesting is that almost half (45%) earn over $80,000 a year! (more…)
Bright Future for Nurses
Nursing is a wonderful profession that presents us a plethora of work settings to pursue our calling. The profession allows many work opportunities to partner with the patient, family, and community promoting well-being and healing to all that we serve. Working in a clinical setting a nurse has face to face interactions with his or her patient which allows the ability to effectively assess the patient’s needs. So what if you had an opportunity to work in a different setting as a nurse while maintaining your nursing skill set? Case management is one opportunity for nurses to put all their knowledge, skills and abilities to work. Assessment skills go beyond the bedside.
For many, nursing is viewed as the persona of a nurse in scrubs with a stethoscope strategically placed around the neck of a nurse entering the room of a patient. As effective change agents in healthcare, we can provide that same exceptional care to our patients where we can work collaboratively to improve patient outcomes and assist our patients in many settings. Moving towards a brighter future enhanced through innovative technology advancements allows us to stay connected through telehealth, electronic records, and patient portals to provide up to date results for necessary delivery of care. Case management is an area in nursing that allows the nurse to hone in on his or her skills and provide advocacy through face to face or telephonic interactions.
Communicating with case managers in the hospital, community and even home settings to connecting with the insurance side for members to provide such essential care is key in our current world of practice. Whether we as nurses arrange home health care needs, collaborate with the transplant registry for a complex patient we manage, provide disease management teaching such as diabetic preventative education or assist a patient after a work-related injury navigating disability or workman’s compensation requirement needs, there is a place for nurses to come together and provide the necessary resource management to patients in order to maintain optimal health. Much of the work of a case manager may begin as preventative management and continues to change as the patient is assisted in meeting his or her needs as medical conditions unfold.
Moving into the future I have learned as a clinician to become more mindful and adaptable to all the changes in healthcare while promoting continued advocacy and coordination of care for patient’s needs to be met. Keeping in mind, the golden rule caring for others the same way we want to be treated as humans all while having our medical needs safely managed. Medical advancements are also proving that life expectancy has changed and people have the ability to take a more active role in the decision-making process. We as clinicians have the ability to support and facilitate the needs for those we serve.
As nursing professionals, education affords us as individuals the requisite skills necessary to provide safe and equitable patient and family-centered care across many venues to support the ethical and cultural needs of the patients. We also have the unique opportunities to learn from the generational and diversified individuals within the workplace. Teamwork and collaboration are paramount within the workplace. Day to day operations is safeguarded with proper adherence to standards of care, health care policy and procedures, and the knowledge, skills, and abilities individuals possess as a whole.
When we place value on collaboration and effective communication through interdisciplinary partnerships positive outcomes benefit the patients we serve. Although nurses work independently, communication and interdisciplinary collaboration enhance patient outcomes. As nurses and care managers we can maintain the organizational commitment as well as safeguard our patients in a rewarding an autonomous role. Want to learn more about a nursing role that can change the life of the patients you serve, learn more about the role of a case manager, and explore the many opportunities that are available in nursing.
Submitted by Guest Author: Lisa Whiffen MSN, RN, CCM
Lisa graduated from Brockton Hospital School of Nursing in Massachusetts in 1988 as a Diploma RN. After graduation, she began working as an RN and charge nurse on a Med/Surg and Hospice unit where she worked full time and began her journey to advance her education. She earned her Bachelors of Science in Nursing at the University of Massachusetts Dartmouth in 1996. Lisa was then recruited by a group of medical internists she worked alongside in the clinical setting to manage their practice as a clinical manager.
Lisa is extremely passionate volunteering her time with her husband and three children at their school, where their motto is “Enter to Learn, Leave to Serve”. She is also a Bereavement Specialist Consultant for the Massachusetts Center for Unexpected Infant and Child Death. In addition, Lisa works as an Associate Lecturer Professor for Curry College in the Division of Nursing in Milton, Massachusetts. When questioned about the future, Lisa smiles and replied: “the future will always be brighter with more nurses, if I can share knowledge to promote the wellbeing of others we care for then I am happy!”
The April Certified Case Manager exam is coming up!
Are you excited? Feeling ready?
Here are a few tips for the last week of preparation.
Day Before the Exam
- Ensure you know where the exam will be administered, and this is a good time to do a “test drive” so you’re aware of traffic issues, where to park, etc.
- Take the day off from studying
- Watch your caffeine intake
- Help prepare your body for sleep by doing a physically tiring activity such as jogging, swimming or biking
Night Before the Exam
- Eat a healthy dinner that won’t cause heartburn or indigestion
- Set out or pack everything you need for the next morning, clothes, notes, directions to the testing center, etc.
- The few minutes right before you go to sleep are great for memorization, read over the main points in your notes, vocabulary words, etc.
- Set an alarm, maybe two, just in case
Case Managers Enjoy Networking and Nightlife in the Heart of Texas
Question: Which U.S. city has a legendary live music scene, has been ranked the 2nd best city to live in, and has “Silicon Hills” as a nickname?
Answer: Austin, Texas Not only is Austin an amazing place to visit, but it is also where the Case Management Society of America will be hosting their 2017 conference.
Have You Considered Attending a Case Management Conference?
Attending conferences is a great way to improve your career. By coming together with like-minded professionals, your opportunities for professional growth and networking are unlimited. Conferences provide the chance to meet industry experts and influencers in person. This year’s keynote speakers include Dr. Mary D. Naylor, Dr. Stuart Robertshaw (Dr. Humor) and Jonathan Mann.
You will learn about new tools to use for case management, expanding your resources, networking with new colleagues and having fun doing it! Additionally, you can break out of your comfort zone, travel to a beautiful city and learn new things in a new space.
Join Us in Austin!
Austin is located in the heart of Texas. The city is home to more than 250 music venues, a vibrant arts scene, a wonderful ballet company, world-class museums, one of a kind shopping and beautiful outdoor spaces. There is truly something for everyone to enjoy in this beautiful city. (more…)