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

Interactive dashboards & analytics in Excel

Copilot and HR: An Introduction for HR Professionals

4-Hour Virtual Seminar on Bootcamp on Excel

Leading Across Generations: 5 Challenges & 10 Strategies to…


I-9 Audits: Strengthening Your Immigration Compliance Strat…

Fair Lending in 2025: New Regulations, Examinations and Enf…


Tattoos, hijabs, piercings, and pink hair: The challenges …

Using Emotional Intelligence to Elevate Your Leadership

ChatGPT & HR: How HR Recruiting Professionals Can Leverage …

FDA Trends in Compliance and Enforcement in Computer System…

Elevate Your Workplace Wellness: 10 Critical Wellness Facto…

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

How to Write a Successful Job Hazard Analysis


How to Write Right for Better Business Communication

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

Public Speaking: Overcoming The Fear of Public Speaking

From Good to Great: The Secrets to an Optimized LinkedIn Pr…



Workplace Investigations 101: How to Conduct your Investiga…

Policy Pops: Navigating DEI in the 2025 Workplace: Strategi…

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

Transforming Anger And Conflict Into Collaborative Problem …


Navigating Alcohol and Drug Addiction Protections Under the…


Reduce Stress in the Workplace: Effective Ways to Handle Co…



Transforming HR with AI: Unlocking Excellence and Innovation

Creating Employee Handbooks that Protect You and Support th…

FDA Technology Modernization Action Plan (TMAP) and Impact …


Transform Data into Insights: A Beginners Guide to Excel Pi…


Mindful Communication:The Key to Meaningful Conversations i…

FDA Proposes Framework to Advance Credibility of AI Models

50+ new Excel features so far this decade

FMLA Compliance in 2025: A Comprehensive Guide & Strategies…

Excel - 10 Key Worksheet Functions to Skyrocket Your Produc…

Managing Toxic Employees: Strategies For Leaders To Effecti…

Hiring and Retaining Employees in this Crazy Economy

Harassment, Bullying, Gossip, Confrontational and Disruptiv…