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Utilization review (UR) allows hospitals to monitor and protect themselves and their patients against unnecessary readmissions. It is important to be compliant with the UR standards to avoid penalties from the Recovery Audit Contractors and the Office of the Inspector General. During this program, attendees will learn about CoPs for UR, the new outpatient MOON forms, state QIOs, and the two-midnight rule. Our expert will provide plans for hospitals to implement in order to comply with the UR standards and prevent unnecessary readmissions.
1. Describe CMS CoPs for Utilization Review.
2. Explain the medical necessity of documentation by the physician in the medical record.
3. Describe what is required for a UR committee.
4. List 3 revised tag numbers.
|- Admission or continued stay||- Changes to accreditation organizations||- UR plan requirements & activities|
|- 3 tag number revisions||- Functions of a UR committee||- Patient service changes|
|- MOON forms||- UR under Tag 652||- UR procedures|
|- Agreement with state QIO||- Discharge screens||- Scope of reviews|
|- Medical necessity||- Observation vs. inpatient admission||- TJC adding UR plan|
|- Two-midnight rule||- Recovery Audit Contractors||- 2018 proposed changes|
|- IMPACT Act||- Physicians & non-physician providers||And so much more!|
Anyone involved with or interested in utilizatoin review, including but not limited to: Utilization Review Committee, Transitional Nurses, UR Nurses, CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Department Directors, Quality Improvement Staff, Physicians, Nurses (all levels), Compliance Officers, CMS Liaisons, TJC Liaisons, Safety Officers and Staff, Ethics Committee Members, Consumer Advocates, Risk Managers, Social Workers, Discharge Planners, Case Managers, Hospice Staff and Regulatory Affairs Staff.