Clinical Co-Management:
A Bridge to Clinical Integration and Pathway to Bundled Payments

  • Cherilyn G. Murer, J.D., C.R.A.
ISBN: 9781498704625
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This book supplies a detailed view of the Clinical Co-Management Agreement (CCMA) framework. It describes how the successful implementation of CCMAs can pave the way to coordinated efforts by hospital administration and physicians to reduce cost, increase quality, and improve patient satisfaction.

Detailing why CCMAs present a viable alternative to conventional hospital-physician alignment models, such as medical directorships, committee chairs, and physician employment, the book presents an insider’s view of the working models for clinical co-management programs.

Complete with a detailed explanation of the self-referral statute (Stark Law) and the Anti-Kickback Statute, this book provides physicians, hospital executives, healthcare attorneys, and industry experts with a trustworthy reference they can refer to prior to and during CCMA negotiations, implementation, and oversight.

Includes a Foreword by Mark D. Birdwhistell, Vice-President for Administration and External Affairs, UK HealthCare

Published by CRC Press, a division of The Taylor and Francis Group, 2015

The Case Management Workbook:
Defining the Role of Physicians, Nurses, and Case Managers

  • Cherilyn G. Murer, J.D., C.R.A.
  • Michael A. Murer, J.D.
  • Lyndean L. Brick, J.D.

 

ISBN: 9781439827772
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This book is a complete examination of the application of the continuum of care which defines the roles of the entire case management team as well as providing an overview of key post acute venues of care in order to achieve an effective and efficient team. It supplies an overview of the process, its structure, and the responsibility of each member of the team. The authors demonstrate that the case management team includes more than just those with the title of case manager. Highlighted is administration’s role to assure patients are at the right place at the right time in their care. A key byproduct of an effective case management system is explored — the realization of an effective integrated health system whereby physicians and hospitals are aligned as caretaker of future health resources. A number of important changes that have occurred in the past 13 years (since The Case Management Sourcebook was published in 1997) are reflected in the workbook as well as the new landscape of healthcare reform.

Published by Productivity Press, a division of The Taylor and Francis Group, 2011

Understanding Provider-Based Status                                          

  • Cherilyn G. Murer, J.D., C.R.A.
  • Michael A. Murer, J.D.
  • Lyndean L. Brick, J.D.
ISBN: 0-8080-0953-2

“Provider-based status” indicating the relationship between a main health care provider, usually a hospital or critical access hospital, and the facilities and organizations that it owns that are located outside of the main hospital (either on-campus or off), is of crucial importance to modern hospital systems. The ability to treat a facility or organization as provider-based directly impacts the hospital’s ability to take advantage of economies of scale, to spread its capital costs over its full facility base, and its level of federal program reimbursement.

Treating (billing) a facility or organization as provider-based used to be largely a matter of saying so. The hospital would include the facility or organization in its Medicare cost report and bill for its services as if it were part of the hospital, with little, if any, oversight from CMS. However, since the establishment of the Outpatient Prospective Payment System (OPPS) in April 2000, CMS has imposed strict requirements on facilities and organizations claiming provider-based status. These requirements apply to every aspect of the facility or organization claimed as provider-based: financial, administrative, and clinical. Failure to comply with any of the established criteria can expose the hospital to liability for overpayments for all cost reporting periods that CMS regards as having been improperly billed. The purpose of this book is to provide you with an easy-to-follow means of assuring that your facility or organization has met all of CMS’ stated criteria so that its continuing ability to claim provider-based status is not jeopardized.

Published by CCH, Inc., 2003

Healthcare Records Management 

  • Cherilyn G. Murer, J.D., C.R.A.
  • Michael A. Murer, J.D.
  • Lyndean L. Brick, J.D.

Co-published with the Healthcare Financial Management Association 

ISBN: 007-134964-2
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The Complete Legal Guide to Healthcare Management gives healthcare professionals an “all-in-one” resource to effectively manage their record-keeping systems. The authors of this comprehensive manual have compiled each individual state’s law and policies covering the various aspects of medical records. Also there are full details on laws regarding records disclosure for cases involving communicable disease and substance abuse, as well as laws pertaining to advancing electronic technology.

Published By McGraw Hill and Co-published with the Healthcare Financial Management Association, 1998.

Post Acute Care Reimbursement Manual 

  • Cherilyn G. Murer, J.D., C.R.A.
  • Michael A. Murer, J.D.
  • Lyndean L. Brick, J.D.

Co-published with the Healthcare Financial Management Association 

ISBN: 0-7863-1248-3
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With the complexity of legal reimbursement issues being the most difficult obstacle to overcome in establishing the success of healthcare facilities, three executives from Murer Consultants, Inc. wrote the Post Acute Care Reimbursement Manual, published by McGraw-Hill and released November, 1997. The key to effective healthcare delivery is through the appropriate use of multi-venues of care along a continuum. Post acute care is comprised of both impatient and outpatient service delivery models.

Post Acute Care Reimbursement Manual, written by Cherilyn Murer, Michael Murer, and Lyndean Lenhoff Brick, is the healthcare executives hands-on reference to reimbursement and legislation for specific venues of care. The changing nature of the Balanced Budget Act turned everything upside down. Post Acute Care Reimbursement Manual focuses on this issue.

Post Acute Care Reimbursement Manual answers specific reimbursement issues, shows how to widen the walls of limitations that policy imposes, provides details of the successful financial operation of healthcare facilities, updates Medicare regulations for post acute care, details emerging venues of care including Medical Day Hospitals and alternative healthcare, and demonstrates how Medicare Risk Contracting serves as a bridge to future reimbursement methodologies.

The Case Management Sourcebook 

  • Cherilyn G. Murer, J.D., C.R.A.
  • Michael A. Murer, J.D.
  • Lyndean L. Brick, J.D.

Co-published with the Healthcare Financial Management Association 

ISBN: 0-7863-1221-1
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A Guide to Designing and Implementing a Centralized Case Management System will provide answers as to how to establish, develop, and maintain a successful case management system that will produce high quality that is modestly priced.

“The Case Management Sourcebook” is a comprehensive guide to understanding, developing and implementing healthcare case management. It includes case studies and selected forms and worksheets that illustrate a model of case management. The book discusses:

  • The importance of case management in the continuum of care
  • How good outcomes can have an effect on reimbursement
  • Different models of case management and how each model should be implemented
  • The legal, cost and expectation-in-care decisions a case management professional must make
Table of Contents
Forward By Mutual of Omaha
Chapter I – The Case For Case Management
Chapter II – Managed Care and the Continuum
Chapter III – Systems of Case Management
- Provider/System Based
- Physician-Directed
- Entrepreneurial
Chapter IV – Learning By Doing: Designing and Implementing a System of Centralized Case Management
Chapter V – The Professional Case Manager: Carving Out a Career Path
Chapter VI – Conflict Resolution: Balancing Legal Duty, Cost and Expectation-in-Care Decisions
Chapter VII – A Case Management Study Model
Chapter VIII- The Future of Case Management
Appendix A – Glossary of Terms
Appendix B – Model Compliance Programs
Resource Guide

Published By McGraw Hill and Co-published with the Healthcare Financial Management Association, 1997.

Compliance: Audits and Plans for Healthcare

  • Cherilyn G. Murer, J.D., C.R.A.
  • Michael A. Murer, J.D.
  • Lyndean L. Brick, J.D.

Co-published with the Healthcare Financial Management Association 

ISBN: 0-07044-462-5
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Compliance Programs for Healthcare, written by Cherilyn G. Murer, Michael A. Murer, and Lyndean Lenhoff Brick introduces the concept of compliance programs, examines the principals of corporate criminal liability, includes benefits and risks involved in establishing a compliance program, and provide rules and regulations commonly encountered in healthcare practice, including Safe Harbor exemptions. Furthermore, the book explains a pre plan audit, the minimum requirements, desired elements, implementation, and operation of a compliance plan, and the correct way to respond to a critical situation that may arise.

Audits, compliance programs, fines, FBI subpoenas and criminal indictments are such a shock to the healing oriented health community that they have no procedures in place until crisis looms. Compliance Programs for Healthcare shows the necessity of implementing an effective compliance program.