Utilization Management Workshop Series: Best Practice Applications for the Hospital Setting Part 2-Utilization Management Series Part 2 Presentation

Utilization Management Series Part 2 Presentation

Pdf Summary

The document discusses utilization management in healthcare, specifically focusing on the roles, definitions, and regulations impacting its implementation in hospitals. The key topics covered include utilization review, medical necessity, the 2-midnight rule, compliance, and the importance of incorporating utilization management into daily case management routines. It highlights the roles of case managers, collaboration with the interdisciplinary team, and the influence of case management leaders in ensuring compliance with regulations. The roles of the Utilization Review Committee, Condition Code 44, and Detailed Notice of Discharge are also emphasized. The document provides guidance on incorporating compliance practices into daily routines, self-audits, and interacting with payers to meet their expectations. It stresses the importance of education, collaboration, and communication within the healthcare team for successful utilization management compliance. The significance of notification requirements, observation services, and understanding regulations like the Conditions of Participation is also highlighted. Lastly, the document includes poll questions, resources for further reading, and contact information for the authors.

Keywords

utilization management

healthcare regulations

utilization review

medical necessity

2-midnight rule

compliance practices

case management

Utilization Review Committee

Condition Code 44

Detailed Notice of Discharge