How Your Hospital is Reimbursed: A Primer for Hospital Case Managers, Social Workers and Case Management Leaders

Beverly Cunningham

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Attend this webinar to get a high-level understanding of how your hospital is reimbursed. Get equipped to be able to guide a patient in decision-making for care, discuss costs for the patient—whether they have Medicare, Medicare Advantage, Medicaid, managed Medicaid, or a commercial payment source.

Why Should You Attend:

In past years reimbursement was not an issue for case management staff. The Payment was based on volume and medical necessity that seemed more clearly understood. As healthcare reform has evolved, healthcare costs have escalated and the strategy of payers to ensure reimbursement only for quality, case management departments must understand the reimbursement process for the hospital and the post-acute care environment. More and more patients make decisions for healthcare providers based on their financial responsibility. This is true with nearly every benefit plan that a patient might have. To guide a patient in decision-making for care, the case management staff member must be able to discuss costs for the patient—whether they have Medicare, Medicare Advantage, Medicaid, managed Medicaid, or a commercial payment source. Even the unfunded patient has choices to make.

Areas Covered in the Webinar:

  • Healthcare industry today and mandate for change
  • Prospective payment
  • Length of stay: What is expected and how it is impacted
  • How we are reimbursed
  • Healthcare reform
  • Managed care
  • Value-based reimbursement
  • Bundled payments
  • Purpose of case management in relation to reimbursement
  • Strategies for the RN case manager, social work case manager and case management leader
    • Understanding reimbursement, its relationship to case management and case management’s relationship to it
    • Collaboration with patients, families and caregivers in relationship to reimbursement

Who Will Benefit:

  • RN case managers
  • Case management leaders
  • Social workers
  • Physician advisors
  • Executives with oversight for case management
Webinar Events
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Training CD-DVD

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Recorded video

Recorded video session

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Speaker: Beverly Cunningham, Consultant, Case Management Concepts LLC

Bev Cunningham, MS, RN, ACM is a founding partner of Case Management Concepts, LLC. She has a 25-year deep working knowledge of case management with specific expertise in denials management, patient flow and the role of the Case Manager and Social Worker in the Case Management process. Bev is also a certified case manager with the American Case Management Association. She has served as a Commissioner on the Commission for Case Management Certification and is a fellow with the Advisory Board. Bev is also the former Vice President of Resource Management at Medical City Dallas Hospital.

She has co-authored a book for hospital case managers—Core Skills for Hospital Case Managers and has written the utilization management chapter in the past two editions of CMSA’s book, Core Curriculum for Case management.

Get in touch

(315) 632-0735,
(315) 750-4379