Medical Case Management Explained

Although many have heard of nurse case management before, people are often unaware or misinformed on what it actually is and what role it plays in the medical care process. Understanding case management nursing will help you understand not only the processes of medical care as a whole, but also how specific diseases or patient problems are managed differently than others, while still providing the care needed.

Brief Description

In short, case management nursing is a medical cost containment service focused on developing a comprehensive care plan, for a specific client, with a specific set of needs, over a long-term period. Most often case management is needed for patients with long-term diseases or injuries such as AIDS patients, workers compensation patients, and even children with long-term conditions. Most case management nurses specialize in a specific area of treatment. This ensures a comprehensive treatment plan for the patients and a more efficient diagnosis and treatment period. It's also common for there to be on-site case management nurses at some specific treatment locations and care facilities.


The basic function of such services is to make sure the care that is needed is received on time and most effectively to meet a patient's and care provider's needs. As simple as this may sound, it's a very complex task. To create the most beneficial cost containment plan, with the utmost results, nurse case management directs and coordinates treatment over the course the entirety of the treatment period including PPO channeling and specialty referrals. For many illnesses such as cancer this can be a lengthy period of treatment including primary care visits surgery, chemotherapy and follow up care. Others such as such as workers compensation and surgery patients may have a smaller period of treatment or may require different considerations for their injuries or health problems.

Proper management can help optimize treatment time as well as recovery time, reducing expenses for care providers and getting those being treated back to work and living normal lives faster. Effectively communicating between patients, insurers and providers ensures comprehensive and timely care and is an invaluable asset to the medical industry as a whole. Undoubtedly as technology and comprehensive treatment continues to improve in the future case management could become a feature of medical care that follows you not only through the term of treatment but post treatment, especially for children who continue with conditions or health issues as they grow.
About this Author

David Hutton serves as an internet marketing source for CompComplete, a medical bill review and Managed Care Services provider in Lawrenceville GA.

Reasons Healthcare Biomedical Equipment Services Are Here to Stay


Question 1: What is the economic outlook for biomedical services? The future outlook for biomedical services is, in fact, very positive.

Comment: Biomedical services have historically been a "sleeper" but significant "cog" in the "accountability" arsenal of healthcare providers. This has been true long before the legislated "accountable care" option was on the table. Do you know that even the U. S. Department of Labor has predicted that a continuous growth for employment for biomedical service technicians and engineers will be much stronger than the average for all occupations through 2016? This "reveal" is predicated, in part, on the increased use of electronic medical devices, biomedical and diagnostic imaging equipment. The obvious benefits of life saving diagnostic, therapeutic and remedial services that are "up and running" are broadcast each day through your balance sheet and also the ultimate consumers......i.e., your VALUABLE patients.

Question 2: How is your biomedical service department currently configured, and are you getting the best value for your dollars spent?

Comment: The need for health care services will continue to increase, and containing your costs will be a major interest to the final results you see in your bottom line. Consider that healthcare services comprise a large percentage of our GNP: Hospitals, Ambulatory Outpatient Surgical Suites, government owned/operated healthcare facilities, and privately owned institutional facilities. It is not going away, folks! The consistent growth of healthcare without any "major new events" or "drivers" is going to increase...along with costs, of course. Biomedical Services that affect your bottom line are a key to cost containment.

Question 3: How are you going to contain costs and increase value with your current biomedical services engineering team, and what alternatives are you considering?

Comment: You must be well aware that competition and reputation within healthcare providers is on the rise. Rarely a day goes by that there are not announcements about some new outpatient surgery centers, private practice consortiums and hospital group consolidations. If you subscribe to any of the top healthcare publications, then you have observed this as well. All of these facilities have to be concerned with marketing their services due to the onslaught of facility options and the fact that consumers are talking a lot online about their healthcare. Biomedical equipment repairs, maintenance and up time are key elements that keep your hospital's reputation "positive" in the minds of your ultimate consumers....the patients. Your patients are tweeting, chatting on Facebook, and talking about your services with very little, if any, concern about legal compliance. Believe us when we tell you that you CANNOT afford to have your reputation sullied because the company handling your technical services and maintenance does not have your best interests at heart.

Question 4: Are you thinking in terms of your patients' happiness quotient and your reputation when delays occur within your facility due to "down-time" of technology?

Comment: It takes an incredible capacity to keep on top of all the new types of compliance models that underwrite an even greater need for accurate diagnostics, preventative maintenance and timely repair of sentinel life saving equipment. Hardly a discussion goes by without some reference to accountable care, meaningful use or electronic medical records with varying context but with little reference to the biomedical technology so important to modern medicine. As such, we enourage you to do some of your own investigating and stay tuned to our informative emails in the future.

Question 5: How are you calibrating your internal biomedical services teams relative to the costs of highly competent and reputable "outsourcers?"

Comment: Your biomedical team is one of the most "mission" critical groups of individuals in your entire hospital as it relates to quality of care. Today, hospitals and outpatient facilities are processing more and more patients with little time for recovery should systems fail, become obsolete or even not get repaired in time for reliable patient care. More often than not, well intended, busy hospitals provide their own "inside" biomets who are normally good "tacticians" engaged in repair, maintenance, and recording of equipment information on a day-to-day basis. Most of these teams are competent at what they know and yet are largely undirected by hospital management staff. Frequently, when an "event" occurs (and it will) with negative consequences, it is typically an issue that management might have addressed proactively as opposed to reactively. Such "events" can trigger huge expenditures for hospitals and outpatient facilities. Risk Mitigation, a "bigger picture" view, biomet human resources management, proactive thinking, industry associations, vendor networks and a seasoned biomedical services management team are all benefits offered by a solid third party resources. These services can translate to huge costs savings for hospitals via effective compliance to regulations as well as timely patient care and ultimately your facilities' reputation.

Tips for Getting the Best Medicare Supplemental Insurance

When seeking the ideal Medicare insurance, you need to get more information on Medicare supplement plans. Usually, these plans will give you the rates of payment as charged by Medicare supplement companies. This means you can use the various information about your preferred plans to establish the insurance plan that will meet your all your needs in the most affordable manner.

The main reason why many people subscribe to Medicare supplemental insurance or these plans is to be able to find the easiest way of meeting all Medicare costs. Given that many individuals have varied needs, many companies offer different supplemental plans to suit different customer needs and preferences. The varied plans cater for different Medicare services meaning you can settle for a plan or package that suits your needs best.

Medicare supplemental insurance is a recommendable way of meeting various medical needs, many companies target the older people mostly aged 65 years and above. However, this does not mean that the insurance only caters for older people as it is perfect when you cannot afford the medical bills of your household. As offered by different insurance organizations, the supplement plan gives the subscribers access to more qualified, affordable, and personalised medical services. Usually, all the medical needs of the subscribers are summarized into one and treated together.

Helpful information on choosing the best supplemental plans

When choosing the best Medicare plans, know that there are plans that offer more advantages than others. When you choose such a plan, you will be able to get more value for your money. The plans also vary from one company to another. The plans may also have different supplement rates. So, regardless of the rate gap that may have been created by the companies, you can still find the best rates and package with a little research on your end.

Helpful research tips

The first factor that you should consider when conducting your research is your monthly medical expenses.

Determine the number of people you would like to cover and the type of existing illnesses or the ones likely to come your way. With this information at hand, you will be able to make a better choice when choosing the most suitable Medicare supplemental insurance. It is also best to check your current insurance and its coverage. Then, settle for a plan that is not covered in your current insurance plan.

Get factual information from your insurance agent in regards to what the Medicare supplemental plans offer.

If you are looking for a fast delivery of services, choose an insurance firm that you have worked with before as they usually have most of the documents needed.

Compare different companies offering Medicare insurance services and settle for a firm that will offer adequate coverage for all your needs.

When making the company comparisons, ask the companies to give you Medicare supplement quotes so that you are able to choose the ideal Medicare supplement rates.

You can make a more informed choice by asking the supplement insurance agent to provide you with all the information you need. Find out if the company has what it takes to meet your insurance needs, know about its financial stability and ability to meet your claim needs, the application procedures and timeline for having your claims approved.
About this Author

Selina Cantu is the author of this article on Medicare Supplement Rates. Find more information, about Medicare Supplemental Insurance here.

Tips for Getting the Right Health Coverage After 65

After you turn 65 the rules for dealing with your health insurance are totally different then they were before you qualified for Medicare health coverage. Even though the government pays many of your medical bills when you join Medicare from that point on, you still need to cover a lot of the costs of your healthcare yourself. You can buy several types of health insurance to fill in those gaps in your Medicare coverage. Here are some tips to help you pick the right health plans that will fulfill your need and pay the best price.

   1. Retiree benefits are generally your best option for health coverage, if you are lucky enough to have coverage through your former employer.

   2. A Medicare supplement policy can fill in many of the gaps standard Medicare doesn't cover if you don't have retiree coverage. When picking a health plan, make sure to assess how much extra coverage you are getting for the additional cost to you.

   3. There are huge Medigap price ranges for no real good reason. Of course that is just an opinion but many agree. Every policy with the same letter designation provides the same exact coverage, and customer service rarely varies to justify paying more. It is generally best to purchase the lowest priced policy for the letter designation you choose. But it is very important that you learn how the insurer sets their prices. Focus on companies with community rated or issue age premiums. These premiums do not rise just because you get older and tend to be lower cost over the long run.

   4. Make sure to give Medicare HMOs a good look. After a big infusion of funds from the federal government, many Medicare Advantage plans are offering very low premiums for prescription drug and healthcare coverage in more parts of the country than ever before.

   5. Everyone who qualifies should sign up for Medicare's prescription drug plan unless they have better coverage through a former employer regardless of their current prescription drug care costs.

   6. Compare more than just premiums when selecting a Medicare prescription drug plan. You need to look at the overall costs and premiums of the drug plan as well as your "out of pocket" expenses under the drug plan for the particular drug you take.

You can contact Medicare directly to find the best plan that will cost you the least each year or work with an experienced Medicare enrollment specialist that has the experience to help you get the most "bang" for your buck.
About this Author

For almost 20 years I have been an active contributor to many online publications. The topics I find interesting range from hobbies such as jewelry making to much more serious topics as healthcare.

The Specialism of Private Healthcare

One of the main positives of private healthcare is that it is easier to get specialist care specific to the health issues a particular patient is suffering from. There are obviously specialists in the NHS for certain key areas, such as cancer, however private healthcare can offer specialist care where it may not be possible on the NHS, which has to cover all bases and provide for everyone within their budget.

On the NHS someone will initially have to visit their GP, even if thdy have a good idea of what the problem is. GP's cover everything and may not have much experience with this particular issue. If using private healthcare services a patient can, if they wish, go straight to a specialist who focuses on this area alone. Dealing with a specialist right from the start can be very beneficial. A patient might be referred to a specialist on the NHS but this will be through their GP.

Some private health clinics specialise in one area and one area only, for example mental health or pregnancy, so the entire clinic is dedicated to this alone. This can be advantageous to patients. They are dealing with practitioners who have a large amount of expertise in this area and they may be able to offer all kinds of services and extra's that might not be available elsewhere.

Specialist doctors can improve the service for patients. The first reason is an obvious one; they have a particular experience and expertise in dealing with the exact problems a patient is suffering from. They can, therefore, be better placed to help as they know this area inside out. It is also possible to receive very specific help rather than just within the same illness or condition. For example, rather than just seeing a bancer specialist, there may be specialists for different types of cancer, and then dietary experts and fitness experts who can advice patients on the lifestyle that is most likely to get them through their illness and prevent it from returning.

Unfortunately, the NHS has to be limited to some extent. It has to serve everyone and there are limited financial resources available to them. Extra services can be available privately that aren't available on the NHS. One example is pregnancy services. There is, of course, good quality pregnancy care on the NHS, but if going private, other services such as extra pregnancy tests are available. This is not a criticism of the NHS, but it is simply impossible for it to offer absolutely every service, so it has to prioritise. With private healthcare there are a wider range of services.

Are private doctors better than NHS doctors? The answer is that it is not the doctors that are better, but they are in a position to be able to specialise and offer more specialist services. They have more time to dedicate themselves to a particular specialism and more time to dedicate themselves to individual patients. This means they can offer a more personal touch and patients have more choice in how they are treated.

Andrew Marshall (c)
About this Author

If you are looking for a Private Doctor London visit the Medical Chambers, who have specialists across a wide range of areas.