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Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmission now receive less money from CMS. This is why there is increased surveillance activity in the area of discharge planning.
This program will cover the CMS (Center for Medicare and Medicaid Services) hospital Conditions of Participation regulations for Utilization Review. Every hospital that accepts Medicare and Medicaid reimbursement must be compliance with these standards. Compliance with the UR standards is more important to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the OIG.
|- Utilization Review under Tag 652||- UR plan requirements|
|- Activities performed in UR plan||- Functions of a UR committee|
|- Agreement with QIO||- MOON Forms for outpatient observation patients|
|- Observation verses inpatient admission||- Admissions or continued stay|
|- Medical necessity determination||And that's just the beginning!|
Anyone involved with or interested in utilization 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.
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