The Dorchester General Hospital Case Management team was recently notified that they have been selected to participate in the CareFirst Gold Card Program. Through this program, CareFirst is recognizing Maryland hospitals that are effectively managing length of stay for inpatient hospital care while reducing the number of insurance claim denials. Shore Health System’s other community hospital, The Memorial Hospital at Easton, was one of the first Maryland hospitals chosen to participate in the CareFirst Gold Card Program in 2007. Memorial Hospital has signed a contract with CareFirst for an additional year in the program.
CareFirst has a practice of assigning utilization review nurses to hospitals at which their covered participants receive care. A CareFirst nurse had been assigned to Dorchester General Hospital five days a week. At each visit, the nurse reviewed patient records to ensure that hospitalizations were necessary and that care was being provided in an efficient and timely manner. As a Gold Card participant, Dorchester General Hospital is no longer subject to the onsite CareFirst utilization review.
Terri Ross, LCSW-C, C-ASWCM, Director of Case Management for Shore Health System, comments, “We are honored to have been selected by CareFirst to participate in their highly coveted Gold Card Program. We continue to show that we provide efficient case management services that not only meet the needs of our patients but also meet the insurance provider’s requirements.”