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Biomedical subjects

J A Micheletti

Publications and source records attributed to J A Micheletti.

At least 19 recordsLinked to original sources
PubMed1995

Using case management to improve claims payment.

Payers increasingly are subjecting claims to intensive review in an attempt to control amounts paid for healthcare services. An internal case management program, however, can help providers better understand and respond to the review techniques employed by payers as well as streamline overall claims processing.

Accounts Payable and Receivable↗
PubMed1995

Case management can reduce costs and protect revenues.

In order to reduce costs, improve quality, and protect revenues, an integrated healthcare system should depend heavily on a case management program that provides continuity of care across all clinical settings for an entire episode of illness or injury. In addition, such a program should move homogeneous, uncomplicated groups of patients quickly and cost effectively through the healthcare delivery system and determine why other patients are not able to move through the system as quickly and effectively.

Continuity of Patient Care↗
PubMed1995

Understanding and operationalizing subacute services.

Providers are now viewing subacute care as an opportunity to market to managed care businesses. Many existing subacute units claim they can provide quality post-acute-care hospital services for considerably less cost than traditional inpatient stays. Subacute units will have to demonstrate both cost savings and quality to be attractive to the market place. Therefore, it is important for nursing managers to understand operational and other aspects of this business.

Humans↗
PubMed1993

Optimizing Medicare reimbursement in skilled nursing facilities.

Effective utilization review (UR) and clear, complete clinical documentation are essential if a skilled nursing facility (SNF) is to capture charges efficiently and bill appropriately to ensure optimal Medicare reimbursement. Authors Micheletti, Shlala, and Greenfield detail how financial managers can assess UR activities and clinical documentation practices to help improve an SNF's profitability.

Documentation↗
PubMed1989

Home health agency reform creates new opportunities for medical record professionals.

Home health care agencies are being required by federal legislation and by accrediting agencies to comply with new, stricter regulations. By providing their expertise in interpreting regulations and establishing quality assurance programs, medical record professionals can place both the agencies and themselves in a "win-win" situation.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1989

Quality assurance in ancillary departments.

Formalizing quality assurance programs is becoming more important in the healthcare arena. Providers are now expected to have programs in place to systematically monitor the outcomes of care delivery. This article describes how to organize and develop quality assurance activities in selected hospital ancillary areas.

Ancillary Services, Hospital↗
PubMed1988

Nursing homes must meet new requirements.

Under the Omnibus Budget Reconciliation Act of 1987, skilled nursing facilities and intermediate care facilities must meet new requirements to receive Medicare and Medicaid payments. These requirements emphasize the quality of care and quality of institutional life. The new law modifies the Medicare and Medicaid certification process and broadens the sanctions that can be applied to substandard facilities. Nursing home administrators must carefully document the additional costs, conduct comprehensive assessments, protect residents' rights, and establish or restructure a quality assurance committee.

Aged↗
PubMed1988

New home health quality standards will trigger operational changes.

As national spending for home health services increases, concern for the quality and the effectiveness of these services grows. Provisions in the Omnibus Budget Reconciliation Act of 1987, which revised Medicare's conditions of participation for home health agencies, and recently adopted standards by the Joint Commission on Accreditation of Healthcare Organizations establish new quality assurance requirements. Home health agencies will need to consider implementing operational changes and other strategies to meet these new standards of quality. Information generated by the new quality assurance activities may be used to establish future Medicare and Medicaid reimbursement rates.

Accreditation↗
PubMed1987

Quality assurance in a PaCS and case-mix environment. Patient Care and Services.

Medicare/Medicaid's new long term care certification survey and case-mix payment systems have important managerial implications for quality assurance programs. These implications are explained in this article and recommendations are made to help skilled and intermediate care nursing facilities function effectively in the new environment.

Certification↗
PubMed1987

Risk prevention: a market for health record services.

The purpose of this article is to identify and discuss the responsibilities of medical record practitioners in helping to minimize hospital risk. Operational programs which can be implemented to ensure integrity of the patient records are also described.

Documentation↗
PubMed1987

Understanding the medical records department improves efficiency.

To asses the efficiency and effectiveness of the medical records department, financial managers need to first learn and understand its internal operations. While some of the tasks, such as coding, filing, and transcribing appear basic, they are all critical factors in avoiding congested workflows and backlogs that could easily result in inaccurate and late payments to the hospital. By asking the right questions and recognizing areas needing improvement, financial managers can help enhance productivity and thereby improve the financial health of the healthcare organization.

Abstracting and Indexing↗
PubMed1986

RUGs II: implications for management and quality in long term care.

Case-mix-based reimbursement could provide long term care facilities with a financial incentive to accept the more acutely ill patients who are being discharged from hospitals under Medicare's prospective payment system. But a financial incentive to maintain a complex case mix could also encourse nursing homes to provide substandard care. New York's Medicaid program has coupled a reimbursement method based on Resourse Utilizationm Groups (RUGs II) with regulatory efforts to ensure quality in a model that may be be adopted by Medicare and by Medicaid programs in other states. This article describes New York's system and discusses a number of management and quality assurance strategies that may be useful to nursing homes under RUGs II.

Activities of Daily Living↗