ACM CERTIFICATION REVIEW CASE MANAGEMENT PROCESS AND PRACTICE

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ACM™ CERTIFICATION REVIEW: CASE MANAGEMENT PROCESS AND PRACTICE © 2018 American Case Management Association.

ACM™ CERTIFICATION REVIEW: CASE MANAGEMENT PROCESS AND PRACTICE © 2018 American Case Management Association. All rights reserved.

TOPICS FOR DISCUSSION Preparing for the ACM™ Examination Structure of the ACM™ Examination Domain

TOPICS FOR DISCUSSION Preparing for the ACM™ Examination Structure of the ACM™ Examination Domain Introduction and Overview Screening and Assessment Planning ACM™ Examination Testing Strategy Applying Information Gathering and Critical Thinking Skills Applying for and Earning the ACM™ Credential Care Coordination, Intervention and Transition Management Evaluation © 2020 American Case Management Association. All rights reserved.

PREPARING FOR THE ACMTM EXAMINATION DETERMINING ELIGIBILITY, READINESS AND MAKING A PLAN © 2020

PREPARING FOR THE ACMTM EXAMINATION DETERMINING ELIGIBILITY, READINESS AND MAKING A PLAN © 2020 American Case Management Association. All rights reserved.

ARE YOU READY FOR THE ACMTM EXAMINATION? Are you a registered nurse or social

ARE YOU READY FOR THE ACMTM EXAMINATION? Are you a registered nurse or social worker? Do you have at least 1 year of experience in Health Care Delivery System Case Management? Do you know your strengths and weaknesses? Do you have good critical thinking skills? © 2020 American Case Management Association. All rights reserved.

YOUR PLAN FOR SUCCESS Use a multi-component approach: ACM Candidate Handbook Accredited Case Manager

YOUR PLAN FOR SUCCESS Use a multi-component approach: ACM Candidate Handbook Accredited Case Manager Certification Study Guide, 2 nd Edition, Electronic Guide Exam Prep Workshop Practice tests and self-assessment exams Other reading/study materials Study groups with other candidates Relevant laws and regulations © 2020 American Case Management Association. All rights reserved.

YOUR PLAN FOR SUCCESS Plan to study at least 5 days a week in

YOUR PLAN FOR SUCCESS Plan to study at least 5 days a week in short segments Time-spaced repetition in study is key to retention! ID strengths and weaknesses and dedicate study time accordingly © 2020 American Case Management Association. All rights reserved.

WHAT TO STUDY www. ACMAweb. or g © 2020 American Case Management Association. All

WHAT TO STUDY www. ACMAweb. or g © 2020 American Case Management Association. All rights reserved.

WHAT NOT TO STUDY The ACMTM exam content is common to Health Care Delivery

WHAT NOT TO STUDY The ACMTM exam content is common to Health Care Delivery System Case Management nationwide. No need to study: State-specific Medicaid regulations Employer policies Proprietary products Local or state policies for specific populations Any very recent or proposed regulations i. e. Medicare Outpatient Observation Notice Rule (MOON) © 2020 American Case Management Association. All rights reserved.

ACM™ DOMAIN INTRODUCTION AND OVERVIEW © 2020 American Case Management Association. All rights reserved.

ACM™ DOMAIN INTRODUCTION AND OVERVIEW © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT SCREENING AND ASSESSMENT © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT SCREENING AND ASSESSMENT © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT PROCESS Assessment Planning (fluid and ongoing) Care Coordination Execution Case Closing and

CASE MANAGEMENT PROCESS Assessment Planning (fluid and ongoing) Care Coordination Execution Case Closing and Evaluation © 2020 American Case Management Association. All rights reserved.

COMMUNICATION Communication is key – both written and verbal Proper assessments must be accompanied

COMMUNICATION Communication is key – both written and verbal Proper assessments must be accompanied by accurate documentation Written communication should “tell the story” to all partners of care Patient and family should be kept informed with necessary information and ongoing updates © 2020 American Case Management Association. All rights reserved.

ASSESSMENT Assessment required by CMS Conditions of Participation Pre-Admission Ongoing Reassessment Generally case manager

ASSESSMENT Assessment required by CMS Conditions of Participation Pre-Admission Ongoing Reassessment Generally case manager uses a “template” or form What are Conditions of Participation? Conditions of Participation (COPs) and Conditions for Coverage (Cf. Cs) are health and safety regulations which must be met by Medicare and Medicaid-participating providers and suppliers. They serve to protect all individuals receiving services from those organizations. © 2020 American Case Management Association. All rights reserved.

INFORMATION SOURCES Patient Delegated caregiver s Family Case managers should utilize all sources of

INFORMATION SOURCES Patient Delegated caregiver s Family Case managers should utilize all sources of information. Why might a community care provider’s input change the discharge plan? How might 3 rd party payor information impact the assessment? 3 rd Party Payors Comm. care providers Medical records Physician s Interdiscip -linary teams © 2020 American Case Management Association. All rights reserved.

COMPONENTS FOR THOROUGH ASSESSMENT Health Behaviors Financial situation Response to Illness Environment Belief and

COMPONENTS FOR THOROUGH ASSESSMENT Health Behaviors Financial situation Response to Illness Environment Belief and Value System Functional status Medical History Developmental level Psychosocial History Current Medical Status and Level of Care Health Literacy © 2020 American Case Management Association. All rights reserved.

SOCIAL DETERMINANTS OF HEALTH Social determinants may impact the patient's ability to adhere to

SOCIAL DETERMINANTS OF HEALTH Social determinants may impact the patient's ability to adhere to a treatment plan and even how they view the importance of health in general. Health Care Communit y and Social Context Food Security Economic Stability Neighborhood and Built Environment Education © 2020 American Case Management Association. All rights reserved.

PSYCHOSOCIAL ASSESSMENT Psychological Purpose: identify barriers to patient meeting his/her goals • • Body

PSYCHOSOCIAL ASSESSMENT Psychological Purpose: identify barriers to patient meeting his/her goals • • Body image concerns Coping skills Emotions/Attitude Learning Beliefs Stress Mgmt. ADL performance Occupation Biological Social Self-care assessments • • Environmental concerns Housing and transportation concerns Physiological Medications Neurochemistry Genetics Family Peers Culture Socioeconomics Family support © 2020 American Case Management Association. All rights reserved.

SCREENING FOR HIGH RISK READMISSION Example: LACE SCORE Identification: Lace Score, 8 Ps, Project

SCREENING FOR HIGH RISK READMISSION Example: LACE SCORE Identification: Lace Score, 8 Ps, Project Red Ed Utilization Admissions Readmissions Age Co-morbid Conditions L • Length of hospital stay A • Acuity on admission C • Comorbidity E • Emergency department visits © 2020 American Case Management Association. All rights reserved.

SCREENING TOOL FACTORS Screening tools take into consideration: Cognitive status Diagnosis/medical conditions Medications and

SCREENING TOOL FACTORS Screening tools take into consideration: Cognitive status Diagnosis/medical conditions Medications and adherence to prescribed plan Care access and/or financial barriers Functional status Social situation Nutrition Emotion (unbiased observations) © 2020 American Case Management Association. All rights reserved.

DOCUMENTATION “If it wasn’t documented, it wasn’t done!” Unbiased observations Family members POA/decision maker

DOCUMENTATION “If it wasn’t documented, it wasn’t done!” Unbiased observations Family members POA/decision maker Barriers to planning Initial plan of care Changes to plan as appropriate Advance directives Resource availability Care team information © 2020 American Case Management Association. All rights reserved.

DOCUMENTATION AS A BRIDGE Case management documentation is a bridge between the various settings

DOCUMENTATION AS A BRIDGE Case management documentation is a bridge between the various settings across the continuum Whether shared electronically or on paper, accuracy, completeness and timeliness are vital to transitions © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT PLANNING © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT PLANNING © 2020 American Case Management Association. All rights reserved.

PLANNING INCLUDES Early development of assessment and primary plan Early involvement of patient and

PLANNING INCLUDES Early development of assessment and primary plan Early involvement of patient and family in the planning process and identification of a spokesperson (Healthcare Power of Attorney) Removes barriers for effective and safe discharge Fosters teamwork and team development for initiation of steps towards discharge. © 2020 American Case Management Association. All rights reserved.

PLANNING INCLUDES Match services and resources to assessed needs Collaborate with stakeholders on an

PLANNING INCLUDES Match services and resources to assessed needs Collaborate with stakeholders on an individualized care plan Establish goals and anticipated outcomes Actively participate in multidisciplinary care rounds/huddles Coordinate patient care conferences when appropriate Educate everyone about the care plan and about options for care © 2020 American Case Management Association. All rights reserved.

PLANNING FOR ALTERNATIVES Evaluate alternative treatment/therapies on: Patient choice Team recommendations Efficacy, cost, safety

PLANNING FOR ALTERNATIVES Evaluate alternative treatment/therapies on: Patient choice Team recommendations Efficacy, cost, safety Potential adherence to the plan Anticipated outcomes © 2020 American Case Management Association. All rights reserved.

PLANNING FOR POST-ACUTE NEEDS When post-acute care needs are present: Educate patient about options

PLANNING FOR POST-ACUTE NEEDS When post-acute care needs are present: Educate patient about options Obtain patient choice of providers Identify a contingency plan if/when needed © 2020 American Case Management Association. All rights reserved.

COMMUNICATING THE PLAN Communication from the physician must be the same as the communication

COMMUNICATING THE PLAN Communication from the physician must be the same as the communication from case manager and from the rest of the team! Communicate with the payor to ensure authorization in place! Documentation counts! Look for exam answers and options that address communication and collaboration. © 2020 American Case Management Association. All rights reserved.

PLANNING: WRAP IT UP WITH A BOW Before the patient “goes out the door,

PLANNING: WRAP IT UP WITH A BOW Before the patient “goes out the door, ” make sure: Teaching is completed Medications are reconciled Payment is ensured. Patient/family are informed Receiving facility/agency is confirmed, if appropriate “Paperwork” goes with the patient Follow up care or appointment identified Look for exam answers and options that address communication and © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT CARE COORDINATION, TRANSITION AND INTERVENTION © 2020 American Case Management Association. All

CASE MANAGEMENT CARE COORDINATION, TRANSITION AND INTERVENTION © 2020 American Case Management Association. All rights reserved.

CARE COORDINATION Relationships: Nursing/Social Workers Physicians PT/OT/Speech Internal Hospital Systems “Pace the Case” •

CARE COORDINATION Relationships: Nursing/Social Workers Physicians PT/OT/Speech Internal Hospital Systems “Pace the Case” • • Right care to the right patient at the right time and in the right place External Systems Patient/Family © 2020 American Case Management Association. All rights reserved.

DISCHARGE PLANNING Facilitating Referrals Home Healthcare (HHC) Durable Medical Equipment (DME) Skilled Nursing Facility

DISCHARGE PLANNING Facilitating Referrals Home Healthcare (HHC) Durable Medical Equipment (DME) Skilled Nursing Facility (SNF) Palliative Care Hospice Care LTACH Acute Rehab Facilitating Key Transition Checkpoints © 2020 American Case Management Association. All rights reserved.

HAND-OFF VS. HAND-OVER Hand-off implies responsibility ends at discharge Hand-over recognizes that CM responsibility

HAND-OFF VS. HAND-OVER Hand-off implies responsibility ends at discharge Hand-over recognizes that CM responsibility extends to ensuring patient is smoothly received by the post acute provider and/or caregiver Should be written and verbal Follow up appointments made Follow up phone calls © 2020 American Case Management Association. All rights reserved.

CARE COORDINATION OUTCOMES Health care dollars are saved Proper use of resources Timely and

CARE COORDINATION OUTCOMES Health care dollars are saved Proper use of resources Timely and appropriate care Case Management is the driver of cost containment and patient’s right to self- determination Prevention of abuse, fraud and waste through proper care coordination Uses the strength of all the team members to develop plan of care and keep the patient at the forefront of the plan of care © 2020 American Case Management Association. All rights reserved.

ETHICAL CONSIDERATIONS Autonomy Beneficence Non-maleficence Justice Fidelity Veracity- truthfulness © 2020 American Case Management

ETHICAL CONSIDERATIONS Autonomy Beneficence Non-maleficence Justice Fidelity Veracity- truthfulness © 2020 American Case Management Association. All rights reserved.

LEGAL CONSIDERATIONS Self-Determination Act Uniform Decision Act Patient Decision Making Capacity Advance Directives ©

LEGAL CONSIDERATIONS Self-Determination Act Uniform Decision Act Patient Decision Making Capacity Advance Directives © 2020 American Case Management Association. All rights reserved.

LEGAL CONSIDERATIONS Victims of Violence EMTALA Incident reporting- Risk management © 2020 American Case

LEGAL CONSIDERATIONS Victims of Violence EMTALA Incident reporting- Risk management © 2020 American Case Management Association. All rights reserved.

NATIONAL PATIENT SAFETY GOALS ID patients correctly Improve staff communication Use medications safely Use

NATIONAL PATIENT SAFETY GOALS ID patients correctly Improve staff communication Use medications safely Use alarms safely Prevent infection ID patient safety risks Prevent mistakes in surgery © 2020 American Case Management Association. All rights reserved.

FISCAL RESPONSIBILITIES Managing to DRGs Optimizing resources Revenue Cycle Hospital Compliance Department Ancillary Departments

FISCAL RESPONSIBILITIES Managing to DRGs Optimizing resources Revenue Cycle Hospital Compliance Department Ancillary Departments © 2020 American Case Management Association. All rights reserved.

MAC, RA & HEAT MAC: Medicare Administrative Contractors RA: Recover Auditors (previously RAC) HEAT:

MAC, RA & HEAT MAC: Medicare Administrative Contractors RA: Recover Auditors (previously RAC) HEAT: Health Care Fraud Prevention and Enforcement Action Team © 2020 American Case Management Association. All rights reserved.

MAC, RA & HEAT Medicare Administrative Contractors (MAC): Function as Medicare oversight and payment

MAC, RA & HEAT Medicare Administrative Contractors (MAC): Function as Medicare oversight and payment Recovery Auditors Act as review coordinators to assure appropriate care is administered an no over or under payment has occurred HEAT task force has FBI and OIG oversight © 2020 American Case Management Association. All rights reserved.

DISCHARGE PLANNING Medicare Regulations Screening Elements Documentation © 2020 American Case Management Association. All

DISCHARGE PLANNING Medicare Regulations Screening Elements Documentation © 2020 American Case Management Association. All rights reserved.

REGULATORY ISSUES Medicare A, B, MA Plans, Part D Medicaid Title XIX Conditions of

REGULATORY ISSUES Medicare A, B, MA Plans, Part D Medicaid Title XIX Conditions of Participation Discharge planning (42 CFR 482. 43) © 2020 American Case Management Association. All rights reserved.

MEDICARE COVERAGE Who’s eligible for Medicare? People age 65 or older, Younger people with

MEDICARE COVERAGE Who’s eligible for Medicare? People age 65 or older, Younger people with disabilities, People with ESRD. Medicare has two parts, Part A (Hospital Insurance) and Part B (Physician charges, OP services). © 2020 American Case Management Association. All rights reserved.

MEDICARE PART A COVERAGE You can get Part A at age 65 without paying

MEDICARE PART A COVERAGE You can get Part A at age 65 without paying premiums if you are: • 65 or over and you or your spouse worked and paid Medicare taxes for at least 10 years. • Receiving retirement benefits from Social Security or the Railroad Retirement Board. • Eligible to receive the above benefits but have not yet filed for them. • You or your spouse had Medicare-covered government employment. If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the US, you may be able to buy Part A. © 2020 American Case Management Association. All rights reserved.

MEDICARE PART A COVERAGE If you are under age 65 you may get Part

MEDICARE PART A COVERAGE If you are under age 65 you may get Part A without paying a premium if you are: Disabled and receiving Social Security or RR Board disability benefits for 24 months You have ESRD: o Benefits start on 4 th month of dialysis in a dialysis facility o Benefits can start the 1 st month if (1) the beneficiary receives training in home dialysis, (2) begins training before third month of dialysis and actually gives in home (self) dialysis treatments • www. medicare. gov/esrd • http: //www. medicare. gov/Pubs/pdf/10128. pdf (pts booklet) © 2020 American Case Management Association. All rights reserved.

MEDICARE COVERAGE Medicare Part A Inpatient care- acute, LTAC, Inpatient rehab Hospice SNF Home

MEDICARE COVERAGE Medicare Part A Inpatient care- acute, LTAC, Inpatient rehab Hospice SNF Home Health (following admission) Medicare Part B Pays the providers Outpatient care © 2020 American Case Management Association. All rights reserved.

MEDICARE Determination of status within 24 -hours Conditions of Participation (Co. Ps) Example: Part

MEDICARE Determination of status within 24 -hours Conditions of Participation (Co. Ps) Example: Part A Coverage per Benefit Period (2016) Hospital Acute Days versus SNF days Rules for placement Depends on available days Benefit Period Lifetime days -60 SNF Home Health Days 1 -60 $1, 288 first day Days 61 -90 $322/day Days 91 -150* $644/day Days 1 -20 Covered in full Days 21 -100 $161/day All days Covered in full 20% of DME *60 “lifetime reserve days” can only be used once. © 2020 American Case Management Association. All rights reserved.

CASE EXAMPLE Patient is admitted to the hospital on October 1 st as an

CASE EXAMPLE Patient is admitted to the hospital on October 1 st as an inpatient and discharged on October 10 th. 9 days of care. Patient is discharged to SNF and stays from October 10 th to October 31 st. 21 days of care. At this point, 30 days of the Part A benefit period have been used (9 days + 21 days). (Continued on next slide…) © 2020 American Case Management Association. All rights reserved.

CASE EXAMPLE Patient is readmitted to the hospital on November 15 th and discharged

CASE EXAMPLE Patient is readmitted to the hospital on November 15 th and discharged on December 1 st. 16 days of care. Patient is again discharged to a SNF and stays between December 1 st and December 31 st. 30 days of care. Since November 15 th, the patient has received care for 46 days. (16 days + 30 days). Between October 1 st and December 31 st, the patient has used 76 days (30 + 46). These are all considered part of the same benefit period. © 2020 American Case Management Association. All rights reserved.

MEDICARE NOTIFICATIONS Code 44 Inpatient to Outpatient ABN/ HINN Letters/ Appeals IMM/ OBS letters

MEDICARE NOTIFICATIONS Code 44 Inpatient to Outpatient ABN/ HINN Letters/ Appeals IMM/ OBS letters Documentation © 2020 American Case Management Association. All rights reserved.

CONDITION CODE 44 SPECIFICS Determined by a UM Committee physician Change from inpatient to

CONDITION CODE 44 SPECIFICS Determined by a UM Committee physician Change from inpatient to outpatient is made prior to discharge A claim has not been submitted The treating physician concurs with the decision Physician concurrence is documented in the medical record © 2020 American Case Management Association. All rights reserved.

MEDICARE NOTIFICATIONS HINN 10 – organization requests a review HINN 11 – when a

MEDICARE NOTIFICATIONS HINN 10 – organization requests a review HINN 11 – when a given procedure or test is not covered during a covered stay HINN 12 – given after an appeal ABN – usually given in the OP area © 2020 American Case Management Association. All rights reserved.

MEDICARE AND YOU http: //www. medicare. gov/publications/ pubs/pdf/10050. pdf www. medicare. gov- coverage for

MEDICARE AND YOU http: //www. medicare. gov/publications/ pubs/pdf/10050. pdf www. medicare. gov- coverage for patients Discharge planning guide www. medicarecompare. gov © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT EVALUATION © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT EVALUATION © 2020 American Case Management Association. All rights reserved.

EVALUATION Why Measure? Quantify Success Identify Best Practices Identify Improvement Opportunities © 2020 American

EVALUATION Why Measure? Quantify Success Identify Best Practices Identify Improvement Opportunities © 2020 American Case Management Association. All rights reserved.

OUTCOME MEASUREMENTS Can be: Global (health care system) Local (departmental/unit) Patient specific Part of

OUTCOME MEASUREMENTS Can be: Global (health care system) Local (departmental/unit) Patient specific Part of practice for: Health care systems Case Management departments Individual Case Managers © 2020 American Case Management Association. All rights reserved.

DATA INTO INFORMATION Data – collection of values Information- data with analysis and meaning

DATA INTO INFORMATION Data – collection of values Information- data with analysis and meaning Standard tools and processes Commonly understood parameters Analysis must be consistent to make comparisons meaningful © 2020 American Case Management Association. All rights reserved.

COMMON NATIONAL BENCHMARK SOURCES CMS Core Measures The Joint Commission Leapfrog Hospital Consumer Assessment

COMMON NATIONAL BENCHMARK SOURCES CMS Core Measures The Joint Commission Leapfrog Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) © 2020 American Case Management Association. All rights reserved.

OTHER SOURCES FOR BENCHMARKS ACMA Standards of Practice and Scope of Services Federal Conditions

OTHER SOURCES FOR BENCHMARKS ACMA Standards of Practice and Scope of Services Federal Conditions of Participation (Co. P) State case management standards Health care system/Hospital policies UM Plan © 2020 American Case Management Association. All rights reserved.

THE UM PLAN UM Committee with at least two physicians Delineate roles and responsibilities

THE UM PLAN UM Committee with at least two physicians Delineate roles and responsibilities for UM Outline standard and outlier review processes Monitor resource utilization Process for coverage determinations, denials, appeals, and peer review Framework for reporting corrective action and documentation requirements © 2020 American Case Management Association. All rights reserved.

KEY PERFORMANCE INDICATORS Length of Stay (LOS) Case Mix Index (CMI) Potentially Avoidable Delays/Days

KEY PERFORMANCE INDICATORS Length of Stay (LOS) Case Mix Index (CMI) Potentially Avoidable Delays/Days Initial UM Review determinations Condition Code Continued Stay Reviews Denials Appeal Outcomes © 2020 American Case Management Association. All rights reserved.

DENIALS AND APPEALS Medical Necessity Not clinically justified Billing requirements not met Missing or

DENIALS AND APPEALS Medical Necessity Not clinically justified Billing requirements not met Missing or incorrect orders Incomplete Condition Code 44 Documentation requirements not met Analyzing denial patterns and comparing with appeal success can identify improvement opportunities © 2020 American Case Management Association. All rights reserved.

PERFORMANCE IMPROVEMENT METHODS AND MODELS Lean Six Sigma DMAIC Lean Six Sigma FADE PDCA/PDSA

PERFORMANCE IMPROVEMENT METHODS AND MODELS Lean Six Sigma DMAIC Lean Six Sigma FADE PDCA/PDSA © 2020 American Case Management Association. All rights reserved.

Create sense of urgency CHANGE MANAGEMENT PRINCIPLES Create guiding coalition Anchor changes Create shared

Create sense of urgency CHANGE MANAGEMENT PRINCIPLES Create guiding coalition Anchor changes Create shared need for change Understand manage resistance 8 -step Chang e Model Consolidate improvements Build influence strategy and communication plan Create shortterm wins Create vision for change Communicate vision Remove obstacles © 2020 American Case Management Association. All rights reserved.

LEAN PROCESS IMPROVEMENT Efficiency Improvement © 2020 American Case Management Association. All rights reserved.

LEAN PROCESS IMPROVEMENT Efficiency Improvement © 2020 American Case Management Association. All rights reserved.

PLAN, DO, STUDY AND ACT Continuous Quality Improvement 1) Plan 2) Do 3) Study

PLAN, DO, STUDY AND ACT Continuous Quality Improvement 1) Plan 2) Do 3) Study (or Check) 4) Act © 2020 American Case Management Association. All rights reserved.

PERFORMANCE IMPROVEMENT METHODS Beginning a PI Project: Creating a New Process Implementing the project:

PERFORMANCE IMPROVEMENT METHODS Beginning a PI Project: Creating a New Process Implementing the project: 1) Define the problem 1) Develop interventions 1) Stabilize new process 2) Identify the stakeholders 2) Develop work plan 2) Evaluate effectiveness 3) Delineate the scope 3) Determine measures 3) Revise as needed 4) Describe the desired outcomes 4) Develop communication plan 5) Identify gaps and barriers 6) Identify contributing factors © 2020 American Case Management Association. All rights reserved.

COMMUNICATING FINDINGS Education of the issue Data supporting the issue Intended process changes Planned

COMMUNICATING FINDINGS Education of the issue Data supporting the issue Intended process changes Planned interventions Goals of interventions Stakeholder involvement and needs © 2020 American Case Management Association. All rights reserved.

CREATING SOLUTIONS Monitoring and patterns Stakeholder involvement Planning and implementing interventions Measuring improvement ©

CREATING SOLUTIONS Monitoring and patterns Stakeholder involvement Planning and implementing interventions Measuring improvement © 2020 American Case Management Association. All rights reserved.

EVALUATING EFFECTIVENESS Experienced case managers should be able to answer: How do I know

EVALUATING EFFECTIVENESS Experienced case managers should be able to answer: How do I know my interventions are effective? How do I know my staff is effective? © 2020 American Case Management Association. All rights reserved.

CASE MANAGEMENT EFFECTIVENESS Identified opportunities for performance improvement, including non-value added processes Compliance with

CASE MANAGEMENT EFFECTIVENESS Identified opportunities for performance improvement, including non-value added processes Compliance with key metrics Orientation and continuing education programs Resource allocation (people and time) © 2020 American Case Management Association. All rights reserved.

QUALITY IMPROVEMENT Denials process Aligning best practices with patient safety Less Avoidable days and

QUALITY IMPROVEMENT Denials process Aligning best practices with patient safety Less Avoidable days and delays measures Staffing justification Ø Falls risk Utilization of services Ø Hand hygiene © 2020 American Case Management Association. All rights reserved.

CULTURE OF CONTINUAL IMPROVEMENT Continually elevate performance expectations Energize and empower staff when participating

CULTURE OF CONTINUAL IMPROVEMENT Continually elevate performance expectations Energize and empower staff when participating in PI activities On-going department education Break down silos between work areas © 2020 American Case Management Association. All rights reserved.

ACMTM EXAMINATION TESTING STRATEGY STRATEGIES AND RECOMMENDATIONS FOR SUCCESS © 2020 American Case Management

ACMTM EXAMINATION TESTING STRATEGY STRATEGIES AND RECOMMENDATIONS FOR SUCCESS © 2020 American Case Management Association. All rights reserved.

AN EXPLANATION OF THE ACMTM EXAMINATION Read the ACM Candidate Handbook! Two sections: 2

AN EXPLANATION OF THE ACMTM EXAMINATION Read the ACM Candidate Handbook! Two sections: 2 hours: General multiple choice (110 items) 90 minutes: Discipline-specific (RN or SW) simulation case studies (5 studies) 10 minute break between sections Scoring: Each section scored separately Each section includes unscored “pretest items” being evaluated for future exams © 2020 American Case Management Association. All rights reserved.

MULTIPLE CHOICE ON THE ACM EXAM It’s okay to guess - no points deducted

MULTIPLE CHOICE ON THE ACM EXAM It’s okay to guess - no points deducted It’s okay to skip questions and come back If you don’t know an answer to a question, look for clues in an earlier/later question on the same topic © 2020 American Case Management Association. All rights reserved.

CORE MULTIPLE CHOICE Domains Structure Time & Quantity Platform/ Environment Screening and Assessment (21)

CORE MULTIPLE CHOICE Domains Structure Time & Quantity Platform/ Environment Screening and Assessment (21) Planning (20 items) Care Coordination, Intervention, Transition Mgmt (34) Evaluation (15) Non-scored, Candidates can A, B, C or D options Test ability to recall, apply and analyze relevant information. skip questions Two hour time limit 110 questions 90 questions scored Candidates can go back and review or change responses ~1 min. per question © 2020 American Case Management Association. All rights reserved.

MULTIPLE CHOICE POINTERS Read the instructions carefully to understand what the question is asking

MULTIPLE CHOICE POINTERS Read the instructions carefully to understand what the question is asking and what kind of choice is needed Look for qualifier words: Always, Never, Most, Least Read the WHOLE question before thinking about an answer; rephrase in your own words If the question is unclear, read through the answers carefully and evaluate which do or don’t fit with the question stem © 2020 American Case Management Association. All rights reserved.

MORE POINTERS Eliminate known incorrect answers first If two choices directly contradict each other,

MORE POINTERS Eliminate known incorrect answers first If two choices directly contradict each other, at least one is incorrect Look for question-answer relationship Judge answers against the question stem, not against each other Sometimes the most specific (longest) choice is the correct answer © 2020 American Case Management Association. All rights reserved.

DISCIPLINE SPECIFIC SIMULATION CASE STUDIES Domains Structure Time & Quantity Platform/ Environment Three parts:

DISCIPLINE SPECIFIC SIMULATION CASE STUDIES Domains Structure Time & Quantity Platform/ Environment Three parts: Candidates 1. Clinical Information Gathering (IG) Decision Making (DM) Scenario 2. Information Gathering Assessment 3. Decision 90 minute time limit 5 studies 4 studies scored cannot skip questions Candidates cannot go back to change responses Making Questions © 2020 American Case Management Association. All rights reserved.

DISCIPLINE SPECIFIC SIMULATION CASE STUDIES © 2020 American Case Management Association. All rights reserved.

DISCIPLINE SPECIFIC SIMULATION CASE STUDIES © 2020 American Case Management Association. All rights reserved.

SIMULATION SCENARIOS 5 simulations, only 4 graded 90 minutes (about 18 minutes per scenario)

SIMULATION SCENARIOS 5 simulations, only 4 graded 90 minutes (about 18 minutes per scenario) Time management is essential No skipping and coming back Differences in Nurse and Social Work tests Case management process the same Discipline-specific focus applied in available choices © 2020 American Case Management Association. All rights reserved.

SCENARIO SCORING Each option has a point weight 1 to 3 points for appropriate

SCENARIO SCORING Each option has a point weight 1 to 3 points for appropriate answer 0 points -1 to -3 points for incorrect answers. Higher weights for answers that are more critically appropriate or more serious errors Questions designed to assess Information gathering- identifying key components © 2020 American Case Management Association. All rights reserved. Decision making- critical thinking skills

SCENARIO TIPS A click will stick - make sure before making a selection Don’t

SCENARIO TIPS A click will stick - make sure before making a selection Don’t read too much into the scenarios Understand the setting - it’s not your workplace Be sure you know what’s being asked Keep the case management process in mind Assessment Planning Care Coordination Evaluation © 2020 American Case Management Association. All rights reserved.

MORE TIPS Watch out for question phrasing Choose the “most important” actions Choose the

MORE TIPS Watch out for question phrasing Choose the “most important” actions Choose the “most relevant” information Don’t think ahead! © 2020 American Case Management Association. All rights reserved.

SCENARIO MANAGEMENT STRATEGY Start the scenario and note the time. Allot about 18 minutes

SCENARIO MANAGEMENT STRATEGY Start the scenario and note the time. Allot about 18 minutes per scenario. Read scenario carefully, noting: • Setting of the scenario • Stage of the CM engagement • Key information or risk factors • What is the essential information required to move to the next stage? DON’T CLICK © 2020 American Case Management Association. All rights reserved.

SCENARIO MANAGEMENT STRATEGY Consider each question carefully, noting: • What exactly is being asked?

SCENARIO MANAGEMENT STRATEGY Consider each question carefully, noting: • What exactly is being asked? • Identify answer parameters (choose all, best, sequence, etc. ) DON’T CLICK Read the response choices, noting: • Do two choices contradict each other? (at least one is wrong) • Do any choices not pertain to the setting or scenario? (consider for elimination) • Are any choices outside the CM practice? (consider for elimination) • Which choice(s) most closely addresses the issue, setting and stage in question? (consider for selection) DON’T CLICK © 2020 American Case Management Association. All rights reserved. © 2016 American Case Management Association. All rights reserved.

SCENARIO MANAGEMENT STRATEGY Decide on your response: • Use scratch paper to note your

SCENARIO MANAGEMENT STRATEGY Decide on your response: • Use scratch paper to note your proposed answer(s) • Review your proposal against the question • Revise as needed Carefully Click on Your Selection(s) Progress to the next stage of the scenario. Repeat the process. © 2016 American Case Management Association. All rights reserved. © 2020 American Case Management Association. All rights reserved.

APPLYING INFORMATION GATHERING AND CRITICAL THINKING SKILLS © 2020 American Case Management Association. All

APPLYING INFORMATION GATHERING AND CRITICAL THINKING SKILLS © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1) Ms. Jane Xavier is scheduled for a total knee

MS. JANE XAVIER (PART 1) Ms. Jane Xavier is scheduled for a total knee replacement. Her surgeon has agreed to participate in a pilot to study the effectiveness of a pre-surgical assessment for discharge planning needs on the length of stay for total joint patients. Ms. Xavier is 75 -years old, a widow, with 2 adult children living nearby. Ms. Xavier’s daughter is very involved in her care and the patient wants her daughter included in all discussions about her care. She lives alone, is independent in all activities of daily living (ADLs), drives, does all of her own grocery shopping and participates in a weekly bridge club. She has a Managed Medicare health plan, a secondary policy through a former employer, and a long-term care insurance policy. The case manager is meeting with Ms. Xavier during a clinic visit 10 days prior to her surgery for a pre-procedure assessment and education. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1) What are the first steps in conducting an assessment?

MS. JANE XAVIER (PART 1) What are the first steps in conducting an assessment? (Select all that apply. ) Verify insurance coverage Evaluate ADLs Establish rapport Verify demographic information in the record Contact the Healthcare POA to request verification documents © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1) What are the first steps in conducting an assessment?

MS. JANE XAVIER (PART 1) What are the first steps in conducting an assessment? (Select all that apply. ) Verify insurance coverage Evaluate ADLs Establish rapport Verify demographic information in the record Contact the Healthcare POA to request verification documents Total Possible Points -1 -1 +3 +2 -2 5 © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART I 1) After rapport is established and demographics have been

MS. JANE XAVIER (PART I 1) After rapport is established and demographics have been verified, the first question the case manager asks is “what is your understanding of the care you will need after this surgery? ” The patient states that she lives completely independently, still drives, grocery shops and attends a Bridge Club weekly. She expects to get back to her normal activities very quickly. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1 I) What are the best next steps of the

MS. JANE XAVIER (PART 1 I) What are the best next steps of the case manager? (Select all that apply. ) Point out that after surgery, everyone requires some assistance, and address this need with the question, “will your children be willing, able and available to provide the physical assistance you will need and to stay with you until you progress to the point where you feel independent again? ” Ask the patient to describe what she understands about the care that will be required when she is discharged and returns home. Show the patient how to use Medicare. gov in the event she needs SNF placement. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1 I) What are the best next steps of the

MS. JANE XAVIER (PART 1 I) What are the best next steps of the case manager? (Select all that apply. ) Point out that after surgery, everyone requires some assistance, and address this need with the question, “will your children be willing, able and available to provide the physical assistance you will need and to stay with you until you progress to the point where you feel independent again? ” Ask the patient to describe what she understands about the care that will be required when she is discharged and returns home. Show the patient how to use Medicare. gov in the event she needs SNF placement. Total Possible Points +2 +3 -3 5 © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1 I) After establishing that the patient has a clear

MS. JANE XAVIER (PART 1 I) After establishing that the patient has a clear understanding of what her care needs will be and that her children are willing, able and available to help her, what are the next questions(s) the case manager will ask? (Select all that apply. ) What is the patient’s insurance coverage? Are there neighbors, or friends, willing to provide assistance? What are the number of steps to get into the house/apartment? Are the bedroom and bathroom on the first floor? Does the patient know if the doors in her home are wide enough for a walker to fit through? © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1 I) After establishing that the patient has a clear

MS. JANE XAVIER (PART 1 I) After establishing that the patient has a clear understanding of what her care needs will be and that her children are willing, able and available to help her, what are the next questions(s) the case manager will ask? (Select all that apply. ) What is the patient’s insurance coverage? Are there neighbors, or friends, willing to provide assistance? What are the number of steps to get into the house/apartment? Are the bedroom and bathroom on the first floor? Does the patient know if the doors in her home are wide enough for a walker to fit through? Total Possible Points -2 -3 +3 +2 +1 6 © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1 I) After assessing the physical environment, what is/are the

MS. JANE XAVIER (PART 1 I) After assessing the physical environment, what is/are the case manager’s next concern(s)? (Select all that apply. ) Determining the patient’s insurance coverage for post-acute services. Clarifying the patient’s prescription benefit, including co-pay requirements. Exploring with the patient her available resources and ability to make copayments. Determining who the patient’s primary care physician is. Determining what home health agency the patient wants to use, if needed. Showing the patient how to use Medicare. gov to assist in choosing a SNF. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART 1 I) After assessing the physical environment, what is/are the

MS. JANE XAVIER (PART 1 I) After assessing the physical environment, what is/are the case manager’s next concern(s)? (Select all that apply. ) Determining the patient’s insurance coverage for post-acute services. Clarifying the patient’s prescription benefit, including co-pay requirements. Exploring with the patient her available resources and ability to make copayments. Determining who the patient’s primary care physician is. Determining what home health agency the patient wants to use, if needed. Showing the patient how to use Medicare. gov to assist in choosing a SNF. Total Possible Points +3 +2 +1 -2 -1 -3 6 © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART III) At the end of the previous assessment, the case

MS. JANE XAVIER (PART III) At the end of the previous assessment, the case manager knows that Ms. Xavier is independent in ADLs and Instrumental Activities of Daily Living (IADLs), drives her car, is cognitively able to play Bridge and has two adult children who she feels will be able to help her (which is her preferred plan). She lives in a single-level home with five steps to get into the house. The railing is on the left side. She knows her doorways are wide enough for a walker because her husband used one before he passed away. She feels she made a wise decision choosing a Managed Medicare policy and feels secure that her secondary policy will cover anything that Medicare does not cover. Her prescriptions are covered by this policy, and the normal copays are reasonable. Ms. Xavier tells the case manager she can pay whatever co-pay she needs to pay. She also has a long-term care policy that helped her when her husband required care prior to his death. Ms. Xavier is cleared for surgery © 2020 American Case Management Association. All rights reserved. and presents to the hospital on the scheduled date.

MS. JANE XAVIER (PART III) Now that patient is in the hospital, and the

MS. JANE XAVIER (PART III) Now that patient is in the hospital, and the surgery has been completed, what are the next best steps of the case manager? (Select all that apply. ) Insist on seeing the patient on the day of surgery to get an assessment completed as soon as possible. Ask the patient’s bedside nurse if the patient is alert and oriented and visit with the patient on the day of surgery. Confirm with the patient that the information in the pre-admission assessment is still accurate and complete. Have a detailed conversation about the patient and her options with the patient’s daughter while the patient is in the recovery unit. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART III) Now that patient is in the hospital, and the

MS. JANE XAVIER (PART III) Now that patient is in the hospital, and the surgery has been completed, what are the next best steps of the case manager? (Select all that apply. ) Insist on seeing the patient on the day of surgery to get an assessment completed as soon as possible. -2 Ask the patient’s bedside nurse if the patient is alert and oriented and visit with the patient on the day of surgery. +3 Confirm with the patient that the information in the pre-admission assessment is still accurate and complete. +2 Have a detailed conversation about the patient and her options with the patient’s daughter while the patient is in the recovery unit. -3 Total Possible Points 5 © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART IV) The case manager sees Ms. Xavier on Post-Op Day

MS. JANE XAVIER (PART IV) The case manager sees Ms. Xavier on Post-Op Day 1 and performs the Admission Assessment, confirming that the information provided at the preadmission assessment has not changed. Ms. Xavier admits to 8/10 pain and states that she refused PT this morning because of the pain. The case manager notices the patient seems mildly confused and attributes that to anxiety and pain. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART IV) What is the case manager’s best response? (Select all

MS. JANE XAVIER (PART IV) What is the case manager’s best response? (Select all that apply. ) Encourages the patient to speak with her nurse about the use of her Patient Controlled Analgesic (PCA) pump. Explains to the patient that participation in physical therapy is critical to achieving her goal of discharge to home. Gives the patient the SNF list and tell her she will likely need rehab since she’s not up and about yet. Reports patient’s poor pain control and confusion to the patient care nurse. Requests that the attending physician order a pain consult. Asks PT to see the patient again. Collaborate with PT to see the patient again early the next day, and prompt PT to coordinate administration of pain medication with nursing so the patient is more likely to participate in therapy. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART IV) What is the case manager’s best response? (Select all

MS. JANE XAVIER (PART IV) What is the case manager’s best response? (Select all that apply. ) Encourage the patient to speak with her nurse about the use of her Patient Controlled Analgesic (PCA) pump. -1 Explain to the patient that participation in physical therapy is critical to achieving her goal of discharge to home. +1 Give the patient the SNF list and tell her she will likely need rehab since she’s not up and about yet. -2 +3 Report patient’s poor pain control and confusion to the patient care nurse. -3 Request that the attending physician order a pain consult. -1 Ask PT to see the patient again. +3 Collaborate with PT to see the patient again early the next day, and prompt PT to coordinate administration of pain medication with nursing so the patient is more likely to participate in therapy. 7 Total Possible Points © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART V) While seeing other patients two hours later, the case

MS. JANE XAVIER (PART V) While seeing other patients two hours later, the case manager hears an overhead page announcing a “Rapid Response” to Room 112. The case manager realizes this is Ms. Xavier who she assessed earlier today and should be going home on Post-Op day 2. The Rapid Response Team finds Ms. Xavier obtunded and unarousable, and she is moved quickly to the ICU. By the time the move is complete, the patient is slowly regaining consciousness so does not get intubated. She remains lethargic and confused. The case manager learns that the patient may have had too much pain medication, and that is what resulted in the loss of consciousness. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART V) What are the next best steps of the case

MS. JANE XAVIER (PART V) What are the next best steps of the case manager? (Select all that apply. ) Contribute to the completion of an adverse drug event (ADR) report in the hospital’s safety reporting system with the bedside nurse on the Ortho Unit. Sees the patient’s daughter in the ICU waiting room, and having heard from the nursing staff that she has been very attentive to the patient and involved in her care, stops to reassure her that her mother is in the best of hands and asks the daughter what she has been told about her mother’s condition. The case manager talks with the daughter about the possibility that the discharge plan may need to change based on the current situation. Hands off the patient to the ICU case manager since Ms. Xavier is no longer on her unit. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART V) What are the next best steps of the case

MS. JANE XAVIER (PART V) What are the next best steps of the case manager? (Select all that apply. ) Contribute to the completion of an adverse drug event (ADR) report in the hospital’s safety reporting system with the bedside nurse on the Ortho Unit. Sees the patient’s daughter in the ICU waiting room, and having heard from the nursing staff that she has been very attentive to the patient and involved in her care, stops to reassure her that her mother is in the best of hands and asks the daughter what she has been told about her mother’s condition. The case manager talks with the daughter about the possibility that the discharge plan may need to change based on the current situation. Hands off the patient to the ICU case manager since Ms. Xavier is no longer on her unit. +1 +3 -2 4 Total Possible Points © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VI) On Post-op day 2, when many total knee replacement

MS. JANE XAVIER (PART VI) On Post-op day 2, when many total knee replacement (TKR) patients are being discharged home, the case manager returns to visit with the patient (who has been transferred back to the Ortho Unit). PT was able to see the patient early in the morning in ICU, and at that time they recommended SNF placement due to slow recovery and continuing lethargy. Ms. Xavier has some residual lethargy and states that she has 5/10 pain but has learned to use the PCA to manage it. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VI) What are the next best steps of the case

MS. JANE XAVIER (PART VI) What are the next best steps of the case manager? (Select all that apply. ) Share the PT recommendation with the patient and her daughter, who is at the bedside. Discuss the SNF placement process with the patient. Inform the patient that, since she has a Managed Medicare policy, she does not have a choice of facilities for SNF placement and will need to go to the facility approved by her payor. Realize that the patient may go beyond a 2 -day stay, so asks her utilization management partner to give the Important Message from Medicare Second Notice (IM). © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VI) What are the next best steps of the case

MS. JANE XAVIER (PART VI) What are the next best steps of the case manager? (Select all that apply. ) Share the PT recommendation with the patient and her daughter, who is at the bedside. +3 Discuss the SNF placement process with the patient. +2 Inform the patient that, since she has a Managed Medicare policy, she does not have a choice of facilities for SNF placement and will need to go to the facility approved by her payer. -3 Realize that the patient may go beyond a 2 -day stay, so asks her utilization management partner to give the Important Message from Medicare Second Notice (IM). +2 7 Total Possible Points © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VII) The patient and her daughter agree that “this is

MS. JANE XAVIER (PART VII) The patient and her daughter agree that “this is more than they expected, ” and they are not as confident of their ability to manage at home. They agree they are fine with the change in discharge plan. The case manager contacts “ABC” Medicare to provide clinical information for pre-authorization. Given the patient’s functional status prior to admission, “ABC” quickly approves SNF placement with authorization to transfer today. The case manager reports back to the patient/family and lets them know that two of the facilities she mentioned earlier have availability, and they need to choose one now because the attending has written a discharge order for transfer to a SNF. The patient/family expresses concern that this is too soon. Ms. Xavier was just in the ICU this morning, and the family wants to go visit the facilities before making a decision. The family states they will contact the physician and their insurance company to appeal this decision. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VII) What are the appropriate next steps in this scenario?

MS. JANE XAVIER (PART VII) What are the appropriate next steps in this scenario? (Select all that apply. ) The utilization manager takes the “Detailed Notice of Discharge” into the patient and her daughter. The utilization manager awaits a call from the QIO that an appeal has been filed. The case manager notifies the SNF that the patient is appealing her discharge, so she will not be transferred today. The case manager notifies the physician that the patient is appealing her discharge. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VII) What are the appropriate next steps in this scenario?

MS. JANE XAVIER (PART VII) What are the appropriate next steps in this scenario? (Select all that apply. ) The utilization manager takes the “Detailed Notice of Discharge” into the patient and her daughter. The utilization manager awaits a call from the QIO that an appeal has been filed. The case manager notifies the SNF that the patient is appealing her discharge, so she will not be transferred today. The case manager notifies the physician that the patient is appealing her discharge. -3 +3 +1 +1 5 Total Possible Points © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VIII) The QIO notifies the hospital that the patient is

MS. JANE XAVIER (PART VIII) The QIO notifies the hospital that the patient is appealing her discharge. They confirm that there is a discharge order on the chart and ask that the record be sent to them immediately. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VIII) Now that the QIO has notified the Hospital of

MS. JANE XAVIER (PART VIII) Now that the QIO has notified the Hospital of the appeal, what should the utilization manager do? (Select all that apply. ) Take the “Detailed Notice of Discharge” into the patient's room and deliver to the patient and her daughter. Call the Managed Medicare Company to alert them to the discharge appeal and to let them know the patient will not be leaving today for the SNF. Tell the patient that she is likely to lose the SNF bed and that may result in her discharge to home instead. Tell PT that the patient has appealed her discharge, so they don’t need to see the patient again in the morning. Document delivery of the “Detailed Notice of Discharge” and the appeal in accordance with hospital policy and Medicare regulations. © 2020 American Case Management Association. All rights reserved.

MS. JANE XAVIER (PART VIII) Now that the QIO has notified the Hospital of

MS. JANE XAVIER (PART VIII) Now that the QIO has notified the Hospital of the appeal, what should the utilization manager do? (Select all that apply. ) Take the “Detailed Notice of Discharge” into the patient's room and deliver to the patient and her daughter. +3 Call the Managed Medicare Company to alert them to the discharge appeal and to let them know the patient will not be leaving today for the SNF. +2 Tell the patient that she is likely to lose the SNF bed and that may result in her discharge to home instead. -3 Tell PT that the patient has appealed her discharge, so they don’t need to see the patient again in the morning. Document delivery of the “Detailed Notice of Discharge” and the appeal in accordance with hospital policy and Medicare regulations. -3 +1 6 Total Possible Points © 2020 American Case Management Association. All rights reserved.

IDENTIFY AREAS OF STRENGTHS AND WEAKNESSES Which areas do you need more review? Which

IDENTIFY AREAS OF STRENGTHS AND WEAKNESSES Which areas do you need more review? Which areas have you already mastered? • Information Gathering • Decision Making • Screening and Assessment • Planning • Care Coordination, Intervention and Transition Management • Evaluation © 2020 American Case Management Association. All rights reserved.

APPLYING FOR & EARNING THE ACMTM CREDENTIAL WHAT HAPPENS BEFORE AND AFTER YOU PASS

APPLYING FOR & EARNING THE ACMTM CREDENTIAL WHAT HAPPENS BEFORE AND AFTER YOU PASS © 2020 American Case Management Association. All rights reserved.

HOW TO APPLY Applications are: • Completed online, processed automatically • Quarterly Exam or

HOW TO APPLY Applications are: • Completed online, processed automatically • Quarterly Exam or Expedited Exam scheduling options • Exams can be scheduled in advance for a certain quarter or expedited. All exams must be scheduled and confirmed for a date within the 3 -month testing © 2020 American Case Management Association. All rights reserved. testing period.

WHAT ARE THE COSTS? Initial Exam Fee: With the ACMTM, you will: Quarterly Scheduling

WHAT ARE THE COSTS? Initial Exam Fee: With the ACMTM, you will: Quarterly Scheduling Option: $349 ü Validate your knowledge Expedited Scheduling Option: $395 ü Earn professional respect Retest Fee: One Portion (Core or Simulation): $190 Both Portions (Core and Simulation): $349 ü Advance your career ü Demonstrate your commitment to provide the best plan of care Recertification (every 4 -years): $195 © 2020 American Case Management Association. All rights reserved.

WHERE TO TAKE THE EXAM Find a testing facility convenient to you! ACM partners

WHERE TO TAKE THE EXAM Find a testing facility convenient to you! ACM partners with PSI/AMP to administer exams, and testing facilities are available across the country. © 2020 American Case Management Association. All rights reserved.

CONGRATULATIONS – YOU PASSED! You will get your ACM-RN or ACM-SW Certificate from the

CONGRATULATIONS – YOU PASSED! You will get your ACM-RN or ACM-SW Certificate from the National Board of Case Management (NBCM) You will be mailed a ACM Lapel Pin You can add the digital ACM credential to your resume, CV and signature © 2020 American Case Management Association. All rights reserved.

MAINTAINING YOUR CREDENTIAL The ACM™ credential is valid for a 4 -year period To

MAINTAINING YOUR CREDENTIAL The ACM™ credential is valid for a 4 -year period To recertify, 40 hours of continuing education are required 30 hours must be specific to Healthcare Delivery Case Management. 10 hours can be non-case management related but must be related to the practice of healthcare in the certificant’s field of practice. © 2020 American Case Management Association. All rights reserved.

MAINTAINING YOUR CREDENTIAL Approved CE Providers Approved ACM educational programs must be sponsored or

MAINTAINING YOUR CREDENTIAL Approved CE Providers Approved ACM educational programs must be sponsored or presented by ACM approved providers, and include courses for which the content/subject matter is specific to either (A) Healthcare Delivery Case Management or (B) related to the practice of healthcare in the certificant’s field of practice. American Nurses Credentialing Center (ANCC) National Association of Social Workers (NASW) Association of Social Work Boards (ASWB) American Case Management Association (ACMA)* All state nursing and social work board approved educational courses *All ACMA courses are approved by both nursing and social work accrediting © 2020 American Case Management Association. All rights reserved. organizations.

MAINTAINING YOUR CREDENTIAL Do: Access the ACM portal to keep up with your CEs

MAINTAINING YOUR CREDENTIAL Do: Access the ACM portal to keep up with your CEs Update your contact information regularly Don’t: Wait until the last minute to upload or take CEs © 2020 American Case Management Association. All rights reserved.