Choices Case Management的动态

Worker’s Comp Tip: Nurse Case Managers If you’ve been injured on the job and filed a workers' compensation claim, you might hear from a Nurse Case Manager or NCM. Today, I want to explain what they do and give you a quick tip to protect yourself if you’re filing a Worker’s Comp claim. The insurance company hires Nurse Case Managers to help coordinate your medical care. They’ll schedule appointments, check on your treatment progress, and communicate with your healthcare providers. While that might sound helpful, remember this: they work for the insurance company rather than for you. In our most recent blog, we go into more depth about the role nurse case managers play in your compensation. If you have a worker's compensation case pending, be sure to check that out and follow us here. . . . . #WorkersCompensation #NurseCaseManagers #BradyLawCares #KnowYourRights #InjurySupport #JusticeForAll #WalpoleMA #WorkersRights #CommunitySupport

Worker’s Comp Tip: Nurse Case Managers If you’ve been injured on the job and filed a workers' compensation claim, you might hear from a Nurse Case Manager or NCM. Today, I want to explain what they do and give you a quick tip to protect yourself if you’re filing a Worker’s Comp claim. The insurance company hires Nurse Case Managers to help coordinate your medical care. They’ll schedule appointments, check on your treatment progress, and communicate with your healthcare providers. While that might sound helpful, remember this: they work for the insurance company rather than for you. In our most recent blog, we go into more depth about the role nurse case managers play in your compensation. If you have a worker's compensation case pending, be sure to check that out and follow us here. . . . . #WorkersCompensation #NurseCaseManagers #BradyLawCares #KnowYourRights #InjurySupport #JusticeForAll #WalpoleMA #WorkersRights #CommunitySupport

State Nursing Pool Licensing Is Crucial for Healthcare Staffing Agencies for Several Key Reasons: 1. Regulatory Compliance: State nursing pool licensing ensures that healthcare staffing agencies comply with state-specific regulations and standards. This compliance is necessary to legally operate within a state, preventing potential legal issues and fines. 2. Quality Assurance: Licensing often involves meeting certain standards of practice and care. By obtaining state nursing pool licenses, agencies demonstrate their commitment to maintaining high standards in the quality of nursing care provided. This can include verifying the qualifications and competencies of nurses and other healthcare professionals they employ. 3. Patient Safety: Ensuring that nursing pools are licensed helps safeguard patient safety. Licensed agencies are required to follow strict guidelines, which include proper screening, training, and continuing education for nurses. This helps ensure that patients receive care from qualified and competent professionals. 4. Risk Management: Licensing helps in managing and mitigating risks associated with healthcare staffing. It ensures that agencies have protocols in place for liability insurance, workers' compensation, and other risk management strategies, reducing the likelihood of legal and financial issues. 5. Market Access: Some states or healthcare facilities require agencies to be licensed before they can provide staffing services. Licensing expands an agency's market access, enabling them to operate in multiple states and serve a broader client base. 6. Reputation Management: Agencies that are properly licensed tend to have a better reputation in the industry. This reputation can attract more clients and high-quality healthcare professionals, leading to business growth and sustainability. 7. Ethical Standards: Licensing often involves adhering to ethical standards and practices. This fosters a culture of ethical behavior within the agency, promoting fairness, honesty, and integrity in their operations. #StateNursingPoolLicensure #HealthcareStaffing #StateLicensing #HealthcareCompliance #CliniSightLLC #Consulting #BetterTogether

Partnering with a nurse-first triage organization can transform how you manage after-hours care. Conduit Health Partners’ experienced nurses used evidence-based protocols to assess and recommend the right care options, saving both time and cost. This model reduces ED visits, enhances patient satisfaction and provides peace of mind—any time of day or night.

Injuries and illnesses don’t keep office hours—but with a 24/7 nurse-first triage line, expert care is always just a call away. By connecting employees to clinical expertise, triage nurses provide timely, evidence-based guidance that improves outcomes, reduces unnecessary ED visits and lowers health care costs. With nearly 90% ED-avoidance rates, the benefits are clear: peace of mind for callers and real savings for organizations. Learn more about how Conduit’s Nurse-First Triage solution can make a difference. https://lnkd.in/gRbA5bbM #NurseTriage #ConduitHealthPartners

Deloitte estimates that technology can free up 13% to 21% of nurses’ time, equating to 240 to 400 hours annually per single staff nurse. ? Even modest time savings can be transformative for nurses with long hours and heavy workloads, allowing more time for patient care and team coordination.? ? Virtual nursing has been shown to ease the burden on bedside nurses across various activities, including significant reductions in nursing turnover rates, improved patient outcomes, and enhanced patient satisfaction. This strengthens the dynamic between care teams, patients, and families, improving patient experience and loyalty.? ? https://lnkd.in/gNKQcKZ8?I #VirtualNursing #DigitalHealth #NurseBurnout #VirtualCare #PatientOutcomes

NSO MEDIA COVERAGE ALERT: As nurse practitioners expand their scope of practice, navigating risk and liability has never been more important. Discover five strategies to help protect your license and career. Via Daily Nurse. https://bit.ly/3V5pdvj #nursepractitioners #NP #NPs #NPlife #riskmanagement #healthcare

Selective Insurance's complimentary nurse triage service (NT24) connects injured employees with registered nurses who can advise on appropriate treatment options 24/7. It helps business owners prioritize employee health and avoid costly claims. NT24 also has a 99% satisfaction rating. Learn more https://lnkd.in/eHCDgS3f #BeUniquelyInsured?

The patient is insured by UMR, and like clockwork, our claims were denied. The reason? According to them, "99214" isn’t billable by nurse practitioners. Anyone remotely familiar with the medical billing world knows this is absolute nonsense. So, we did what we always do: we re-sent the claim, meticulously checked our work, and re-submitted it. Denied again. Over and over, the same absurd denial. Next, we filed an appeal. By fax. Denied again. The exact same reason every time. So, we tried the most dreaded path of all—calling provider support. The once-frustrating maze of phone trees has now evolved into a dystopian nightmare of fully automated systems, devoid of human contact. There’s no option to appeal. No path to resolve. Just cold, sterile, automated dead ends offering to fax me a copy of the same denial. Determined, we called repeatedly, trying every possible option in the phone tree until desperation led us to lie to the machine, telling it we wanted to "provide additional medical information." It worked—finally, a human voice! But that glimmer of hope was extinguished almost immediately. The rep, kind but powerless, admitted, "I can’t assist with claims at all." I explained the situation. He agreed it sounded like an error but didn’t know who could fix it. I asked to be escalated to a supervisor. None available. I asked again, "Who manages appeals, what do we do when the automated process gets it wrong?" He sighed and said, "That’s the golden question—we get these calls all the time." It felt hopeless. So I switched tactics. I called the patient support line, pretending to be the patient just to get a human on the phone. When I explained the issue, the patient rep confirmed what we already knew—this wasn’t right. She could see the claim, and even she agreed it was probably processed incorrectly. But she didn’t have the tools to fix it either. I begged. And for the first time, someone took pity. She escalated the claim and flagged it for reprocessing. This was victory, but it felt hollow. To resolve a claim that should’ve been paid immediately, it cost me and my staff over $1,500 in labor. For what? A reimbursement that will barely cover a fraction of that. The system isn’t broken. It’s functioning exactly as THEY designed. It’s a system that thrives on exhausting providers until they give up. It’s a system that preys on patients, pushing the bills back into their hands when their providers can’t break through the bureaucracy. It’s a system built to profit from frustration, from time wasted, and from the hope that someone, somewhere, will just give up. Burn it down.

Aimee Delaney reviews the practical and legal obstacles faced by nursing homes and industry associations who are seeking to challenge a new staffing mandate issued by the Centers for Medicare & Medicaid Services (CMS). Learn more in our summary: https://lnkd.in/gYHFScws Via Skilled Nursing News #Healthcare #NursingHomes #Nursing #LegalNews