Apr. 1, 2015

Transitions of care, regulatory issues and the frontline case manager, ethics and more
E-Learning platform offers timely topics in case management
ACMA's E-Learning platform offers a variety of recorded sessions for purchase on-demand. The E-Learning Center is a cost-effective option for continuing education. Below are just a few of the topics explored in our on-demand sessions, and new topics will soon be available.

Content can be accessed 24/7 from any location — all you need is an internet connection.

Discounts for Multiple Users
Purchase five users for one session and you will automatically receive the fifth session free at check out. Simply enter a quantity of five and you will see a discount appear for the amount of one user. This discount is not limited, so you may purchase multiple groups of five users for one session, or multiple sessions for five users each and you will receive one free session every time!

Please Note: This discount does not apply when purchasing a session series where you already receive one session free when purchasing the entire series.More

RAC, OBS, 2-MN, AMA, TOC — We speak your language
In the alphabet soup that is today's healthcare system it is sometimes hard to find people who understand and relate to the unique issues you face each day. It is often even more difficult to find education, tools and resources designed specifically for you and the challenges of your practice.

Network with like-minded colleagues and glean best practices, practical strategies and advice from case management and transitions of care leaders at the 2015 ACMA National Conference, April 26-29 in Phoenix, Arizona. To learn more about what makes this conference unique, go to More

ACMA National Conference hotel room blocks are selling out fast!
We are now on our second overflow hotel — the room block at the Hyatt Regency Phoenix is sold out and there are only a few rooms remaining at the Renaissance Phoenix Downtown. ACMA has secured attendee rooms at the Hyatt House in Scottsdale/Old Town, but these rooms won't last long! To learn more about this year's conference hotels and reserve your room online, click here. More

Election results: ACMA National Board of Directors
The National Board of Directors election is complete. ACMA is fortunate to have had a great slate of candidates with a commitment to serve ACMA.

Congratulations to those elected:

Board Member-at-Large (nurse)
Maureen Zukauskas, MS, BSN, RN, ACM, CPHM
Nurse Manager, Case Coordination
Hartford Hospital
Hartford, Connecticut

Board Members-at-Large (social worker)
Heather Kirby, BSW, CCM, ACM
Vice President, Integrated Care
Frederick Memorial Hospital
Frederick, Maryland

Stacy Wright, MSW, LCSW, MHA, MBA
Senior Director, Corporate Case Management
Novant Health
Charlotte, North Carolina

Members-at-Large will serve a two-year term beginning at the 2015 Annual Meeting in Phoenix on April 28, 2015, and ending at the 2017 Annual Meeting (date and location TBD).More

Improve your department's efficiency with Compare
ACMA's Compare provides powerful tools and benchmarking to facilitate change related to avoidable delays, readmissions and denials.

If you would like to know more about Compare and evaluate it for your organization, please contact James Nickerson at

Support ACMA's fundraising efforts
In order to continue to make a difference and ensure your voice is heard, we need your assistance.

Be an advocate and support ACMA today.More

The healthcare standard
According to the 2013 National Hospital Case Management Survey, nearly half (47 percent) of case management departments prefer the ACM certification — the preferences of the remaining 53 percent of departments are divided among 4 certifications, with the ACM leading the next most preferred certification by more than 20 percent.

Set yourself apart
The current health care environment demands qualified case management professionals — set yourself apart with the ACM certification. If you are not yet ACM certified, apply now at and put the ACM credential after your name.More

The tangible benefits of physician engagement
According to author Barry Ronan: I am often asked how I engaged physicians as we were transitioning to value-based care delivery. After conferring with my executive team, I created the President's Clinical Quality Council, which proved to be an excellent way to engage our providers. I asked six physicians who were the early adopters on the medical staff if they would join the council. I then asked them to identify six of their colleagues whom they thought would be strong additions to the group.More

AHA survey: Hospitals appealing nearly half of RAC claim denials
AHA News Now
Hospitals continue to appeal Recovery Audit Contractor claim denials, according to the latest report from the AHA's quarterly RACTrac survey. Hospitals participating in the fourth quarter of 2014 survey report appealing 46 percent of all RAC claim denials, with a 69 percent overturn rate in the appeals process. In addition, more than half of all appealed claims are still sitting in the appeals process, and hospitals report that claims audited under the RAC prepayment demonstration have, on average, a greater dollar value than claims audited retrospectively.More

Hospitals are wrong about shifting costs to private insurers
The New York Times
To hear some hospital executives tell it, they have to make up payment shortfalls from Medicaid and Medicare by charging higher prices to privately insured patients. How else could a hospital stay afloat if it didn't? But this logic is flawed. Study after study in recent years has cast doubt on the idea that hospitals increase prices to privately insured patients because the government lowers reimbursements from Medicare and Medicaid.More

Transcript: No senate 'doc fix' vote before recess. Will break hurt chances?
Kaiser Health News
According to speakers Mary Agnes Carey: Welcome to Health on the Hill, I'm Mary Agnes Carey. The troubled Medicare Physician payment formula is one step closer to repeal. After 17 short-term fixes over the last decade, the House of Representatives voted overwhelming to scrap Medicare’s Sustainable Growth Rate, or SGR, and replace it with a system that pays doctors based on the quality of care rather than the quantity.More

SCOTUS: Medicaid providers can't sue states to raise reimbursement rates
Kaiser Health News
In a 5-4 decision, the high court ruled that hospitals and other healthcare providers can't sue a state in an effort to have Medicaid rates increased in keeping with rising medical costs. The U.S. Supreme Court ruled in a case from Idaho that private medical providers that deliver residential care services cannot sue a state in [an attempt] to raise Medicaid reimbursement rates to deal with rising medical costs. The justices, on a 5-4 vote, ruled in favor of the state of Idaho, which asserted that medical providers have no legal recourse to sue. More

5 principles to help hospital leaders improve on the Triple Aim
Hospital leaders have proposed a new set of care principles to reflect the post-Affordable Care Act healthcare landscape, according to an opinion piece in JAMA co-written by former Centers for Medicare & Medicaid Services Administrator Donald Berwick. Several major healthcare organizations, including Intermountain Healthcare, Kaiser Permanente, Contra Costa Health Services and HealthPartners, have formed a Leadership Alliance aimed at helping one another, patients and communities achieve the Triple Aim of lower costs, improved patient experience and improved outcomes, according to Berwick and his coauthors, Derek Feeley and Saranya Loehrer, M.D. More

Providers plan to pursue Medicare's chronic care management program
By Scott E. Rupp
Kryptiq conducted a benchmark survey to gauge providers' pursuit of the newly available payments in light of the Centers for Medicare and Medicaid Services starting to reimburse providers last Jan. 1. Caregivers who actively manage care delivery for Medicare patients with two or more chronic conditions are able to receive payment for the services if they use a certified electronic health record, obtain and manage patient consent, deliver five core care management services and provide at least 20 minutes of follow-up outside of the office in conjunction with the chronic care management program.More