For case management, ESS is partnered with our sister company Case Management Innovations. CMI offers facilities a solution with a 24/7 remote call center that provides quality, first-level, admission reviews and education for your staff and providers. This solution is much more cost-effective than adding staff and has a large potential return on investment by ensuring that legitimate admissions are recognized while improper admissions, which are typically targeted by auditors, are avoided. Our process is extremely simple to use and rapid turnaround keeps patients moving and your throughput times down.
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Case Management
Our Case Management solution is included as part of our comprehensive services.
Case Management Innovations can also be utilized as a standalone service.
While ESS offers case management offers ED as part of our services. Case Management Innovations is a company dedicated to the support of Case Managers and Utilization Review Managers by providing 24/7 remote coverage. If you’d like to learn more about how Case Management Innovations can serve your facility find out more here.
Hospital Cases
Emergency Staffing Solutions provides education for case managers and physicians to improve documentation and assist with getting the patient into the correct disposition status. As part of our program management, we have an array of services, consultation and on-site or online educational training for physicians and case management professionals. Clinical leadership, facility input or documentation audits often reveal opportunities for improvement at your facility.
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Contact ESS to get more specific information on how we can help you.
Our Team
Our team of case managers is extensive. A team includes clinical nurses, physicians, billing and coding specialists, healthcare administrators and attorneys. Everyone will be focused on providing the tools and services needed to ensure the appropriate patient flow from the admission through any potential denial periods.
Improper Admissions
The problem we face today is that approximately 60% of admissions from the emergency department occur after traditional business hours when most hospitals do not have case management services to assist with the level of care decisions. the risk of getting it wrong can be costly. CMS estimates $5.7 billion in improper payments related to improper admissions.
Admission Review
ESS offers admission reviews 24 hours per day 365 days per year. Not only does this ensure proper admissions and categorization of patients, but this will also save the case manager substantial time when attempting to manage errors that occurred overnight or over the weekend. These solutions are very beneficial to our facilities.
- Remote case management support 24/7 for guideline review for admissions
- Confirm appropriateness of admissions
- Capture appropriate admissions
- Improve level of care determinations
Documentation Support
- Training physicians on Physician certification
- Supporting level of care
- Minimizing RAC vulnerabilities
RAC Preparedness Audits
Mock Recovery Audit Contractor (RAC) audits to determine a facility’s vulnerabilities for RAC denials. Subsequent recommendations for improvement to minimize the potential for denials.
RAC Appeals
Phone call follow up for discharged patients to confirm that they have full understanding of their discharge plan to reduce readmissions
*Note: service and/or training costs may not be included within facility contract.
Policy/Procedure Support
- Condition Code 44
- Post-discharge Reviews
- Physician Certification
RAC Appeals
- Complete RAC appeal process management through three levels of appeal.
- Support the organizations internal RAC appeal process with expert review and letters of support.