Day 1 – January 28, 2025  Session II
Hepatic Encephalopathy:
Current Pathway for Care Resolution and Best Practices for 2025…
Case Managers, A Must Hear!

Hepatic encephalopathy (HE) is a serious neurological complication of liver cirrhosis characterized by the reversible loss of normal brain function. The HE patient population presents many challenges for case managers, because it is associated with hospital readmission, impaired patient and caregiver quality of life, risk of falls, and mortality.    The major factor is that Hepatic encephalopathy is associated with the most subtle cirrhosis-related complications. It is this factor which leads to the to the high volume of hospital readmissions, necessitating that case managers possess the most current knowledge and interventions associated with a reduction in readmission rates especially after an hepatic encephalopathy-related hospitalizations. The updated information critical for the best case management practices necessary for success outcomes is presented in this lecture.

Day 1 – January 28, 2025  Session III
Discharging Chronic Respiratory Patients on NIV

In 2024, greater than 35 million people in the U.S. live with chronic obstructive pulmonary disease (COPD). These patients suffer from several complications and co-morbidities, including physical disabilities limiting functionality, frequent lung infections, anxiety, and depression impacting their social determinants of health, leading to poor health outcomes and increased mortality rates. These issues are the impetus for the hospital case managers to create a safe, quality-driven discharge plan to reduce readmissions.  The lecture will review COPD-associated risks and current treatment modalities for respiratory management. The discussion highlight will include the different ventilation support devices, insurance coverage criteria, and their importance in the discharge plan component for the patient and their family,  making this information a must for case managers caring for the COPD patient.

Sponsored by AdaptHealth

Day 2 – February 8, 2025  Session I
Understanding the Medicare Maze,
what you need to understand about Medicare in 2025

This session will help the attendees:
Understand changes to the Medicare Discharge Planning Conditions of Participation and learn about offering choice and delivering required notices.

Develop a process for delivery of the Medicare Change of Status Notice, understanding new MCSN regulations, applicability and completion of Medicare Change of Status Notice form.

Understand the requirements for screening for Social Drivers of Health, presentation will review the social drivers and discuss reporting requirements.

Day 2 – February 8, 2025  Session II
Hospital Capacity and Strategies for Clearing the ED:
The Case Manager’s Role!

Hospital capacity and clearing the ED is a critical issue that hospitals face on a daily basis, often creating pressure for case managers to decompress these areas. This lecture taught by experts presents IHI and other national leader’s recommendations and initiatives which improve patient flow. A primary focus is on the benefits of implementing a “Repatriation Program” and a real-time example is provided. Through this lecture participants are able to choose at least three initiatives which can prove beneficial in their own facilities improving hospital throughput.

Day 2 – February 8, 2025  Session III
Best Practices in 2025 for Successful Appeal of Medicare Advantage Inpatient Post-Acute Denials!*:
*1.5 CCM Ethics approved

The appeal and overturn of hospital inpatient post-acute denials recently became a hot topic when it became evident that the American public was dissatisfied with health insurance providers and their growing number of care denials. This lecture explains the components of a  successful Evidence-Based Appeal Process focusing on the overturn of post-acute denials  based on the results of a 3-year Evidenced-Based Project (EBP). The project resulted in the development of Standardized Appeal Guidelines resulting in a 78% denial overturn rate. During this lecture, a detailed description of the components of the EBP Appeal Guidelines is provided making it possible to apply the guidelines to most hospital settings.

One of the major purposes for the use of the EBP Appeal Guidelines  is to ensure the hospitalized Medicare Advantage patients can access equity of care who are denied access to their rehabilitation stay necessary for full recovery. These denials primarily exclusive to the Medicare Advantage patients not only denies them the rights to rehabilitation care, but also, increases length of stay, impacts hospital bed availability and throughput (AHA, 2023). To further emphasize the importance of this project’s outcomes, both CMSA and ACMA Standards of Professional Practice clarify that it is the case manager’s role to appeal denials and doing so, reflects best practice.