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

Video Transcription

Video Summary

The video discusses the importance of proper utilization management in hospitals to comply with regulations such as the two midnight rule set by CMS. In a specific scenario outlined, a patient initially in observation service for two nights before being considered an inpatient aligns with the criteria of the two midnight rule. It emphasizes the significance of tracking timing and criteria for patient status determination. Compliance with regulations is crucial, necessitating understanding of rules, providing notifications to patients, and conducting medical necessity reviews. Leadership plays a vital role in educating staff, ensuring adherence to payer policies, and fostering collaboration. Designated roles in utilization management streamline processes for efficient care delivery. Maintaining compliance is essential for hospitals to offer quality care, avoid penalties, and manage financial liabilities.

Keywords

utilization management

hospitals

regulations

two midnight rule

CMS

observation service

inpatient status

patient status determination

compliance

notifications

medical necessity reviews

leadership

payer policies

collaboration

efficient care delivery