Published Sep 27, 2022
Is is the norm for CM calls to be recorded, critiqued, and then given a grade by management? Please chime in ! TIA
I have worked case management for several years from home. I have never had my calls recorded.
Jill Squire BSN RN OCN
I am a Complex Case Manager for a moderately sized health insurance company. Our calls are recorded and we are to give a disclaimer within 15 seconds of the call beginning.
Health Insurance is highly regulated through Medicare and cases are audited by National Committee for Quality Assurance (NCQA).
The recorded calls are audited to ensure that the standards established by Medicare are met as well as those established by NCQA; and that the case manager's documentation matches the conversation. Insurance companies stand to lose a lot of Medicare reimbursement if they do not meet certain quality standards.
If you follow standard operating procedure and tools given to you to help you meet your standards of care for your case management and individual cases, you should be fine. It is intimidating at first to realize you are being recorded, but do your best, follow the guides and use the tools given to you and you will feel much more natural before you know it.
Be the patient advocate that you are while meeting the criteria in the conversation - make a cheat sheet if you need to, to guide yourself through your conversation. Be your authentic professional self.
Create well-written care plans that meets your patient's health goals.
This study guide will help you focus your time on what's most important.
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