Case Management Updates For 2022 And Beyond!

Toni Cesta

Toni Cesta

Toni Cesta, Ph.D., RN, FAAN is partner and health care consultant at Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models and providing on-site education to case management staff, and strategies for assisting health care...
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Pre-recorded
60 Mins
Toni Cesta

Healthcare is a rapidly evolving business. With that, case management departments and professionals must remain current and compliant with new regulatory changes, updates, and best practices. The Centers for Medicare and Medicaid Services (CMS) updates the Conditions of Participation for Utilization Review and Discharge Planning annually. Sometimes there are no significant changes, but in the last two years, both utilization review and discharge planning have progressed in terms of regulatory changes, as well as best practices and IT solutions.

In this webinar, our expert speaker Toni Cesta will review the most recent best practices for utilization review including new information technology solutions that support this role and can make it more efficient. She will discuss the new Conditions of Participation for discharge planning that went into place two years ago. These new expectations from CMS include the additional functions we must perform. In order to be compliant in your practice, you must have a working knowledge of these new requirements and how these affect the practice of case management professionals. Documentation requirements related to discharge planning are more comprehensive than they have been in the past and require that the physician of record participate in the discharge planning documentation as well. Discharge planning must be a team effort. In order to demonstrate that is, documentation must be timely, comprehensive, and complete.

Finally, this webinar will discuss best practices in terms of model designs, roles, and staffing ratios. While models are very important, the staffing ratios to support them are equally as important. We will review the staffing ratios for the most frequently used models, the integrated model, and the collaborative model.

Webinar Objectives


It can be difficult to remain current in your role as a case management professional when your practice and daily work life and busy and you are constantly on the move. Rather than having to read through numerous publications and online information, this webinar will summarize the need-to-know elements of the regulatory issues affecting your practice.

In the recent past, the Conditions of Participation were updated to include additional responsibilities for case managers and physicians. These changes require modifications to the ways in which discharge planning is performed and documented. Case management professionals must be compliant with these new requirements.

Newly emerging IT solutions geared toward clinical reviews are emerging that can help facilitate the UR process.

There are best practices for design, roles, and staffing ratios.

Webinar Agenda


  • Conditions of Participation for Utilization Review and how to ensure compliance
  • Emerging IT solutions for utilization review
  • Conditions of Participation for Discharge Planning
  • Updates to the Conditions of Participation for Discharge Planning
  • Changes in practice and documentation needed in response to the new discharge planning requirements
  • Best practice case management roles and models
  • Best practice staffing ratios for case management departments

Webinar Highlights


  • Compliance as it relates to utilization management 
  • Conditions of participation for utilization review
  • Components of a compliant utilization review plan
  • Components of a compliant utilization review committee
  • Emerging IT solutions for utilization review
  • Updated Conditions of Participation for discharge planning.
  • Regulatory requirements associated with discharge planning.
  • Best practice case management models
  • Best practice roles for RN and social work case managers
  • Best practice staffing ratios

Who Should Attend


  • RN Case Managers
  • Social Workers
  • Directors of Case Management
  • Directors of Social Work
  • Physician Advisors
  • Medical Directors
  • Directors of Compliance
  • Directors of Nursing
To access this webinar, kindly reach out to our customer support team at support@complianceducator.com.

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