(11th edition, 2012) – An important 2-volume resource for utilization management and claims departments to improve care and cost-savings . 1,260 pages include more than 1,750 detailed clinical review criteria guidelines, evidence-based benefit interpretations listing specific indications for medically necessary ambulatory … Continue reading
Managing Behavioral Healthcare
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3rd edition (update 2012) 434-page manual provides behavioral health medical review policies, ‘benefit interpretations’ criteria, benchmarks and guidelines for inpatient, day hospital, residential and outpatient care. A practical model for a quality-based and cost-effective care management approach as well as … Continue reading
Managing Physical/Occupational/Speech Therapy and Rehabilitation Care
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767-page 3-volume compendium of detailed review criteria policies and guidelines for outpatient (adult and pediatric) Occupational, Physical and Speech Therapy + inpatient and outpatient acute and long-term rehabilitation services. The number of therapy visits (and time per visit for modalities) … Continue reading
Managing Post-acute Care and Other Extended Care Services
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2nd edition, 2012 – 2 volumes: policies, procedures and tools to 1) improve efficiency and quality while controlling the cost of care in a skilled facility or rehabilitation service, as well as home care, and 2) provide methods and criteria … Continue reading
Medical Group Practice: Policies and Procedures
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A ‘how-to’ manual of cost-effective, quality-driven policies and procedures for the efficient management of medical group practices and other health care provider offices. Improve productivity, day-to-day medical practice management procedures including infection control, medical record and consent policies and procedures. … Continue reading
Utilization Management and Capitation Strategies
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A 485-page tool box of resource utilization management (UM) model policies, procedures and plans that ‘work’ for traditional, streamlined, open access and other cost-effective management strategies. Contact capitation and other variations of traditional capitation compensation strategies are detailed including those … Continue reading
The Credentialing and Privileges Manual
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3rd Edition (2012 update) 426 page tool box of credentialing policies, procedures, competency criteria and core privileges with delineated privilege checklists for all physician specialties plus all licensed allied health professionals or nonphysician clinicians. Health systems, health plans, hospitals and … Continue reading
Disease State Management Strategies II. Clinical Behavioral Health Guidelines
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2nd edition (update 2012) – Valuable evidence-based clinical guidelines for the effective management of common, costly behavioral health disorders including Attention-deficit Hyperactivity Disorder (ADHD), Alzheimer’s disease, Alcohol/substance abuse and dependency, Major depression, Bipolar, Obsessive-compulsive, and Anxiety/phobias/panic disorders including PTSD, Personality … Continue reading
Disease State Management Strategies I. Clinical Guidelines for Primary Care
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2nd edition (update/revision 2012 – Detailed medical (asthma, COPD, diabetes, hypertension, smoking cessation, cardiovascular disease prevention, hormonal therapy, heart failure) and obstetrical (LOS and prevention of preterm deliveries) care protocols plus preventive health care standards by age and sex with … Continue reading
Case or Care Management
(Third edition – 2012 update) Plans, policies, procedures and strategies that ‘work’ to improve quality, efficiency of care while controlling unnecessary costs. Specific case management effectiveness data by disease entity and behavioral healthcare conditions for children and adults. Forms. Patient … Continue reading
Infection Control in Ambulatory Care
126 pp of ‘best practice’ policies and procedures to help meet OSHA, Joint Commission, NCQA and other standards for accreditation and certification visits in a medical office or an ambulatory care setting. Resources include forms, OSHA standards, Surgical safety checklist; web … Continue reading
Neurology and Neurosurgery – Clinical Review Criteria Guidelines for Managing Care
Evidence-based clinical and review criteria guidelines for outpatient and inpatient tests and procedures with indications, medical necessity coverage criteria, authoritative references and resources ++ Alzheimer disease & ADHD page clinical guidelines – both with extensive references and resource materials. 2nd … Continue reading
Speech-Language Therapy: Clinical Review Criteria Guidelines
Comprehensive clearly written guidelines for adult & pediatric speech-language pathology therapy + related tests, DME and hearing-related therapy & procedures. Authoritative references/resources including informative speech-language web links. 114 pp. Updated annually. $65. List of Contents Speech Therapy Services – skilled, … Continue reading
Hospitalists
Policies and procedures to develop a practical and physician-friendly hospitalists program – designed to improve and streamline patient care from the ER through discharge and transitional care period. Credentialing criteria and example job description for hospitalist physicians and managers. Billing … Continue reading
Concierge or Retainer Practices
A ‘how-to’ plan for a concierge or retainer medical practice. Concierge, boutique, premier, platinum or retainer medical practices are being carved out of existing solo and group practices to permit time to provide expanded preventive services and practice amenities not … Continue reading
Health Care Provider Job Descriptions, 2nd edition updated
Medical directors, physician, nurse, nurse practitioner, nurse midwife, anesthetists, physician assistants, utilization management department staff and many other licensed and non-licensed health care personnel job descriptions plus competency, performance improvement, audit or evaluation tools, counseling policy, Employee handbook policies including sexual harassment … Continue reading
Obesity: Behavioral, Medical and Surgical Management
Effective overweight and obesity treatment requires a triad of behavioral, nutritional and physical activity modifications. A basic program is clearly presented that includes information for self-management of weight reduction, plus when needed, the prerequisites for drug or surgical management. This 205 … Continue reading
Managing Unplanned Readmissions
Innovative strategies, tools required to improve care while avoiding any need for hospital readmission Extensive references, resources, web links. New 2011; updated for 2012 - 88 pages. $65. List of Contents Preface, Disclaimers Table of Contents – by section The Issues … Continue reading
Disposable Medical Supplies/Durable Medical Equipment (DMS/DME)
Hundreds of specific review criteria for disposable medical supply and DME Items, plus an alpha list with explanatory recommendation for basis to deny or approve for payment based on usual coverage ‘medical necessity’ determinations. References, web links. This publication is … Continue reading
Medical Staff Peer Review
3rd edition, update 2012 – The information and tools needed for an effective peer review program by any medical organization – includes policies & procedures, competency and behavioral assessment tools and strategies, Committee structure, medical staff resources, legal resources and … Continue reading
Emergency Care Management
A toolbox of guidelines, benefit interpretations, policies and procedures for the effective management of appropriate and medically necessary emergency and urgent care services. Includes strategies for after-hours, emergency care, plus review criteria guidelines to develop an effective after-hours and emergency … Continue reading
Complementary and Alternative Medicine / ‘Wellness’ Guideline
A toolbox of general information, guidelines and benefit interpretation for the effective clinical and resource management of alternative medicine and preventive health care services. Includes alternative medicine clinical review criteria guidelines, resources, references, web sites ++ preventive health care (‘Wellness’) … Continue reading
Healthcare Performance Improvement: Plans, Policies & Procedures
Strategies, example plans, programs, forms, tools, and resources needed for an effective quality and performance improvement program in a medical group, hospital or health plan. 166 pp. Updated annually. $65. List of Contents Introduction Disease management Clinical Guidelines DM in … Continue reading
Stroke, Cardiac & Pulmonary Rehabilitation
Stroke, cardiac & pulmonary rehabilitation clinical review criteria guidelines for ambulatory care, inpatient admission, continued stay and discharge; plus clinical care and prevention guidelines, literature resources and web links. 161 pages. 2012 update. $65. Contents Stroke rehabilitation Introduction Key components … Continue reading
Radiology, Radiation Therapy and Nuclear Medicine
Review Criteria Guidelines and Clinical Issues Clinical review criteria guidelines for radiology (including indications for MRI/CT), radiation therapy and nuclear medicine. Health plan and Medicare benefit interpretations with useful references and related web links. 132 pages. 2nd edition, Updated annually. … Continue reading
Major Depression and Bipolar Disorder
Clinical guidelines for the evaluation and management of these 2 common disorders with extensive references and resources. 112 pages. Updated annually. $65. Major Depression Guideline Table of Contents (Bipolar disorder table of contents follows) Introduction & Epidemiology Women and depression … Continue reading
Pay for Performance (P4P)
P4P history, concepts, pros, cons, quality issues, example programs now functioning successful, Medicare plans for P4P compensation, extensive references, resources, web links, benchmarks. 96 pp. Update 2012 $55. List of Contents Introduction/Disease Management/Guidelines Pay for Performance Bridges to Excellence Commonwealth Fund … Continue reading
Anxiety, Phobias & Panic Disorders Guidelines
Clinical guidelines for the evaluation and management of common anxiety disorders, panic disorder and guidelines for Post-traumatic stress disorder (PTSD) and Obsessive-compulsive disorder (OCD). Extensive references and resources follow each of the 3 guidelines. 83 pages. Updated 2012. $55. [Contents lists … Continue reading
Alcohol / Substance Abuse & Dependency
Clinical guideline for screening, evaluation and management of alcohol and substance abuse disorders with extensive references and resources. Review criteria for out- or inpatient care – admission, continuing care and discharge are included. 95 pages. Second edition, Updated annually. $55. … Continue reading
Alzheimer’s Disease – Evaluation and Management
Diagnosis of Alzheimer’s and other dementias, non-pharmaceutical and pharmaceutical management of this common cluster of disabling disorders. References. Web links/other resources. 70 pp. Updated annually. $55. Table of Contents Preface Introduction to this volume References list for the introduction Evidence-based … Continue reading
Attention Deficit Disorder (ADHD) – Evaluation and Management
ADHD diagnosis, non-pharmaceutical and pharmaceutical management in children, adolescents and adults. Comprehensive references. Web links/other resources. 70 pp. Updated annually. $55. Table of Contents Preface Introduction to this volume References list for the introduction Evidence-based Medicine web sites Behavioral Health … Continue reading
Asthma – Evaluation and Management
Contents Preface Disclaimers, Copyright and proprietary protection notice Introduction Action Plans AAHP/HIAA study findings JCAHO proposed standards for clinical guideline use in hospitals Introduction – Asthma Diagnostic criteria for asthma Prevention of asthmatic symptoms and asthma Exercise-induced asthma Exercise recommendations … Continue reading
Glossary of Managed Care Medical Terms, Abbreviations & Acronyms
Great resource for spelling, use of correct abbreviations, and definition of healthcare-related acronyms for any medical office staff or facility. Managed Care, Medicare, Vision Care plus common legal terms are defined. “Do Not Use” list of medical abbreviations. 4th edition: … Continue reading
Chronic Obstructive Pulmonary Disease (COPD)
Asthma – diagnosis, evaluation and management; health plan and Medicare benefit coverage guidelines. Authoritative references and resources. Update 2012. $55. Contents List Introduction Screening Pulmonary function tests (description, indications): Blood gases Diffusion capacity, Lung compliance Exhaled Nitrous Oxide Lung volumes Metacholine challenge … Continue reading
Diabetes mellitus – evaluation and management
Diagnosis, non-pharmaceutical and pharmaceutical management to improve the quality of diabetic care while reducing the overall cost. Comprehensive references. Web links/other resources. 2012 update: 114 pp. Updated annually. $65. Contents Introduction Prevention of diabetes The ‘metabolic syndrome’ or the ‘insulin … Continue reading