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CMC Process

CMC Physician Case Management Process

 

CMC development teams are available to assist hospitals and health systems clients in utilizing CMC’s services without any infrastructure requirements. CMC Physician Advisory and Case Management Programs are designed and customized to work seamlessly with clients hospitals admission, case management, and utilization review processes.

 

24/7 Real time Physician Advisor Services

CMC Senior Physician Advisors and Utilization Review nurses provide daily services to CMC’s hospital clients. CMC Physician Advisors are available real-time 24/7.

The CMC admission review process utilizes evidence-based medicine and CMS guidance in order to ensure appropriate admission/observation status certification, resulting in the highest level of compliance with CMS rules and regulation thereby enhancing revenue integrity.

By using proprietary software, evidence-based care guidelines, and algorithms to determine appropriate admission/observation status, CMC Physician Advisors are able to provide admission status certification compliant with CMS rules and regulations.

RAC Rapid Response Team

CMC’s RAC Rapid Response Team is a ready-to-go unit consisting of experienced and technology-supported physician teams specifically designed to assist hospitals, health systems and providers in preparing and responding to RAC request for clinical information.

Rapid Response Teams are deployed on short notice to assist hospitals and health systems in responding immediately to RAC request for clinical information enabling the hospitals to be in compliance with the deadline for providing clinical information.

CMC’s RAC Rapid Response Team is also available to perform retrospective clinical denial reviews, and provide independent expert physician advice throughout the entire RAC audit appeal process.

Case Management Programs

CMC Case Management Teams work directly with hospitals, home health agencies, physicians, and other providers and family members to ensure that medically complex patients recently discharged from the hospital receive well-coordinated care within and across all healthcare settings and levels of care.

Our case managers coordinate outpatient services to facilitate patients’ hospital discharge to home or community-based settings, helping patients to avoid costly and repeated inpatient hospital stays while ensuring continuity of care.

A team of physicians and case management nurses will:

  • Perform comprehensive reviews of a patient’s medical condition
  • Collaborate with physicians, treatment facilities and family members regarding treatment plans and ongoing care coordination needs
  • Provide ongoing monitoring for exacerbations and new conditions
  • Make recommendations to primary care and home care physicians on medically necessary interventions

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