Help with Cost Savings and Documentation?

  1. I'm brand new at this but an oncology nurse for 15yrs. I work for a private oncology care mgmt program. We do case/disease mgmt...clients could be re-insurer, TPA or even employer. We fall between CM and DM. We approve medical treatment plan for cancer, network status of provider, tons of pt ed on dx, tx, s/e, etc, monitor the pt, assist with changing care settings (ie. Neupogen at home). We complete monthly reports on clinical status, etc and cost savings. I find the documentation of Savings, Cost Avoidance, etc somewhat difficult. Some are cut and dry (hard savings). WHat I find hard is how to my interventions/supports provide savings? Many of us struggle with this. I would love your thoughts, policies, a sample of documented savings or even standards on how you document (soft) savings, cost avoidance,etc. How do you document patient ed...I have heard from other DM forum's that they document as "cost avoidance" b/c you reviewed neutropenia and since the patient wasn't admitted for 2 days for febrile episode that you avoided a $4000.00 in-patient stay. Do others do that?
    I can't seem to find guidance or references...so any input would be much appreciated.
    Thanks in advance for any replies.
    •  

close