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The Hospital Guide to Contemporary Utilization Review

Author : Stefani Daniels

Publisher :

Page : 0 pages

File Size : 45,10 MB

Release : 2015-04-16

Category : Hospital utilization

ISBN : 9781556452147

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Book Description

The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations. The book covers a range of topics, including compliance with the UR Condition of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best practice hospital utilization review (UR) program Describe the legal obligations of the hospital to comply with chapter 42 CFR 482.30 of the Conditions of Participation (CoP) Use the publication as a tool to assess his or her own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Facilitate the development of a contemporary UR committee Assess an organization's opportunities to improve processes to benefit patient care and hospital success Recommend compliant language for the organization's UR plan Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives



The Hospital Case Management Orientation Manual

Author : Peggy Rossi, Bsn, Mpa, CCM

Publisher : Hcpro, a Division of Simplify Compliance

Page : 0 pages

File Size : 42,33 MB

Release : 2014-06-12

Category : Health services administration

ISBN : 9781615692910

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Book Description

The Hospital Case Management Orientation Manual Guide is a comprehensive resource that supplements of initial training for new case managers. This book explains what to document, where to document it to ensure appropriate level of care and reimbursement, and how to avoid unnecessary denials. This book's focus is utilization management, discharge planning, and relevant CMS regulations. It can help new case managers learn how to perform their jobs effectively on their own time. It can also serve as a wide-ranging resource for more experienced case managers, particularly those whose training was less than adequate.







The Leader's Guide to Hospital Case Management

Author : Stefani Daniels

Publisher : Jones & Bartlett Learning

Page : 356 pages

File Size : 44,51 MB

Release : 2005

Category : Medical

ISBN : 9780763733544

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Book Description

This text will address the role of the hospital case manager from a busniess perspective rather than a nursing perspective. Will engage all areas that are involved with the health care system, in pursuit of global objectives on behalf of every stakeholder.



The CMS Hospital Conditions of Participation and Interpretive Guidelines

Author :

Publisher :

Page : 546 pages

File Size : 45,27 MB

Release : 2017-11-27

Category :

ISBN : 9781683086857

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Book Description

In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.



Health-Care Utilization as a Proxy in Disability Determination

Author : National Academies of Sciences, Engineering, and Medicine

Publisher : National Academies Press

Page : 161 pages

File Size : 33,92 MB

Release : 2018-04-02

Category : Medical

ISBN : 030946921X

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Book Description

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.





Registries for Evaluating Patient Outcomes

Author : Agency for Healthcare Research and Quality/AHRQ

Publisher : Government Printing Office

Page : 385 pages

File Size : 50,42 MB

Release : 2014-04-01

Category : Medical

ISBN : 1587634333

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Book Description

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.