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Handling this process without any dedicated tools or (even) with outdated technology is troublesome, at best.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.
Is this the most relevant information for Acute care case managers that perform initial and concurrent reviews?
I took and passed the CCM exam . Do I need or will it help me in my current role as an acute care CM to take the ACM? Is there any/other literature that can enhance my skills ?
In my opinion, you can never have enough certification. I believe ACM would be the next most logical choice for you with the information you provided.