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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 UR standards to avoid penalties from the recovery audit contractors and the Office of the Inspector General. During this program, attendees will learn about what information hospitals must have implemented from the CMS CoPs for UR. Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmission now receive less money from CMS.
So, what's in your UR plan? Does your hospital have a contract with your state QIO? Is there concise documenting in the chart regarding medical necessity and compliance with the Two-Midnight rule? Our expert will discuss the new MOON forms and provide plans for hospitals to have all necessary documents in their medical records.
|- UR under Tag 652||- 2017 proposed changes||- Admissions or continued stay|
|- Functions of UR committee||- UR procedures||- Medical necessity|
|- 3 Tag number revisions||- UR plan goals||- RAC|
|- UR plan requirements||- Observation vs. inpatient admission||- Two-Midnight rule|
|- Conflict of interest||- Composition of UR Committee||- Intensity of services|
|- Choosing Wisely||- Image Wisely||- Discharge screens|
|- MOON Forms||- Physicians & non-physicians providers||- Agreement with QIO|
|- Frequency of reviews||- Decision making process||- IMPACT ACT|
|- UR plan activities||- Scope of reviews||And there's more!|
Anyone involved with or interested in compliance regulations and standards, including but not limited to: CEOs, CFOs, COOs, CMOs, CNOs, CE Directors, Quality Improvement Staff, Physicians, Nurses (all levels), Compliance Officers, Health Information Management Staff, Infection Preventionist, QAPI Staff, CMS Liaisons, TJC Liaisons, Registration Staff, Safety Officers and Staff, Pharmacy Staff, Ethics Committee Members, Consumer Advocates, Risk Managers, Legal Counsel, Behavioral Health Staff, Psychiatry Staff, Social Workers, Discharge Planners, Case Managers, Hospice Staff and Regulatory Affairs Staff.