Compliance Measures For Case Management
Learn the compliance rules case managers must follow, including the Conditions of Participation, 2-Midnight Rule, NOTICE Act, Important Message, HINNs and patient choice.
Speaker
Toni G. Cesta
Case management consultant · Case Management Concepts, LLC · Ph.D., RN, FAAN
Overview
Compliance is now a regular part of Joint Commission and CMS audits, and it matters for patients too. This case management compliance webinar reviews the rules that most affect daily utilization management and discharge planning.
You'll cover the Conditions of Participation, compliance at access points, the 2-Midnight Rule and observation, the NOTICE Act, the Important Message from Medicare, HINNs and changes in patient choice. The Joint Commission monitors these issues for deemed-status hospitals, so they affect your survey results.
The session also covers balancing quality and cost, documenting for compliance, running a compliant UR committee and performing a gap analysis to find and fix compliance gaps.
Why attend: The Joint Commission, other regulators and CMS are auditing hospitals and case management departments against the Conditions of Participation and other requirements. Every case management professional needs to know how these rules affect their practice. The session suits directors of case management, quality and social work, compliance officers, RN case managers, social workers, hospitalists and physician advisors.
What’s covered
- Compliance overview for case managers
- Balancing quality and cost
- The Conditions of Participation
- Compliance at 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
- A compliant UR committee
Who should attend
What you get
About the speaker
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 information on current issues and trends in case management. Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program and systems process improvement. Dr. Cesta has also held positions as Corporate Vice President for Patient Flow Optimization and Director of Case Management. She also designed and implemented a Master’s of Nursing in Case Management Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York. Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

