As case managers we must be aware of the myriad of compliance issues that we must adhere to in our daily practice. Never has this been more important to our work as case managers then it is now. Our ability to remain compliant has become an element of audits from accrediting bodies such as the Joint Commission as well as the Centers for Medicare and Medicaid Services (CMS). It is the right thing to do for patients as well.
This program will review the compliance issues that most greatly impact your practice such as the 2-midnight Rule, the NOTICE Act, HINNs, The Important Message and others. The Joint Commission is now monitoring these issues when they have deemed status from Medicare, so your compliance is critical to a good Joint Commission survey outcome. This program will help you to identify where you may have compliance practice gaps as well as how to fix them!
WHY SHOULD YOU ATTEND?
Case managers and social workers need to maintain compliance in a number of areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments for compliance with the Conditions of Participation as well as other regulatory requirements. Every case management professional needs to know how these requirements impact their professional practice.
AREA COVERED
- Compliance overview for case managers
- Balancing quality and cost
- The Conditions of Participation
- Compliance at the access points
- The 2-Midnight Rule and Observation
- The NOTICE Act
- The Important Message from Medicare
- The HINN
- Changes in Patient Choice
- Utilization management and compliance
- Documenting for compliance
- How to perform a compliance gap analysis
- Compliant UR Committee
LEARNING OBJECTIVES
- Understand the compliance issues required under the Conditions of Participation for Utilization Management and Discharge Planning.
- Describe your responsibilities as they relate to Observation and the 2-Midnight Rule.
- Your requirements to be compliant with the Important Message from Medicare.
- Explain how the patient choice lists are used.
- Understand the different types of HINNs and when they should be given.
- Document for compliance
WHO WILL BENEFIT?
- Director of Case Management
- Compliance Officer
- RN Case Managers
- Director of Quality Management
- Director of Social Work
- Social Workers
- Hospitalists
- Physician Advisor
Case managers and social workers need to maintain compliance in a number of areas directly related to utilization management and discharge planning. Both the Joint Commission (and other regulatory bodies) as well as the Centers for Medicare and Medicaid Services (CMS) are auditing hospitals and case management departments for compliance with the Conditions of Participation as well as other regulatory requirements. Every case management professional needs to know how these requirements impact their professional practice.
- Compliance overview for case managers
- Balancing quality and cost
- The Conditions of Participation
- Compliance at the access points
- The 2-Midnight Rule and Observation
- The NOTICE Act
- The Important Message from Medicare
- The HINN
- Changes in Patient Choice
- Utilization management and compliance
- Documenting for compliance
- How to perform a compliance gap analysis
- Compliant UR Committee
- Understand the compliance issues required under the Conditions of Participation for Utilization Management and Discharge Planning.
- Describe your responsibilities as they relate to Observation and the 2-Midnight Rule.
- Your requirements to be compliant with the Important Message from Medicare.
- Explain how the patient choice lists are used.
- Understand the different types of HINNs and when they should be given.
- Document for compliance
- Director of Case Management
- Compliance Officer
- RN Case Managers
- Director of Quality Management
- Director of Social Work
- Social Workers
- Hospitalists
- Physician Advisor
Speaker Profile

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, educating case management professionals and assisting in implementation of case management departmental changes. The author of nine books, and a frequently sought after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and …
Upcoming Webinars

Female to Female Hostility @Workplace: All you Need to Know

Maximizing Productivity with ChatGPT: AI Solutions for HR, …



2-Hour Virtual Seminar on Empowering Presentations with Pow…

Pivot tables beginner to advanced + 20 advanced Pivot table…

Understanding Artificial Intelligence (AI) & using Chat GPT

Creating Loyal Customers Through Excellent Customer Service

Understanding and Communication New Immigration Policies (2…

Navigating Talent Management and Retention Strategies.

HIPAA is Unsettled – Safe Compliance Strategies

Project Management for Non-Project Managers - Scheduling yo…

How to Prepare For and Host a FDA Inspection and Respond to…

Empowering Conflict Resolution: Letting Go to Gain Control

Onboarding Best Practices for 2025: Proven Strategies to Po…

Navigating 2025 Employment Laws: What Every Employer Needs …


Managing Toxic Employees: Strategies For Leaders To Effecti…

How to Conduct Exit Interviews - Implementing and Enhancing…

Adapting to Change: Strategies for Personal & Team Resilien…

Introduction to Excels Built-In Solver – Advanced Decision-…

How to Manage the Legal Landmine of the FMLA, ADA and Worke…

FDA Technology Modernization Action Plan (TMAP) and Impact …

Design Control for Medical Devices Including Verification/V…

Stress, Change And Team Resilience Through Humor: An Intera…


Developing and Implementing Quality Culture in the Organiza…

GROUPBY and PIVOTBY functions. Pivot table killers?


Negotiating Skills For Professional Results - Winning Strat…

Use the power of AI to turbocharge your MS Excel


Trust in Leadership: Building and Maintaining Trust as a Le…

Conquer Toxic People - Learn To Protect Yourself And Get Yo…

Excel - Pivot Tables - The Key To Modern Data Analysis and …

AI and Human Resources: The Great Opportunity!

Tools and Tactics for Grieving, Surviving, and Thriving in …

Bootcamp for New Managers and Supervisors: Develop These Es…

How To Conduct An Internal Harassment And Bullying Investig…

How Generative AI can be used in Banking Risk and Compliance

Creating Employee Handbooks that Protect You and Support th…

Excel Power Skills: Master Functions, Formulas, and Macros …

Emotional Intelligence: Mastering the Emotions of Great Lea…

Managing Toxic & Other Employees Who Have Attitude Issues


The Five Cs Of Commercial Credit: The Basic Elements Of Cre…

SOPs - How to Write Them to Satisfy those Inspectors

Improving Employee Engagement & Retention Through Stay Inte…


How to Give Corrective Feedback: The CARE Model - Eliminati…