If your utilization review (UR) committee is like many others nationwide, it may not have actually met in years-and chances are your UR committee members are secretly glad that's the case. Let's face it; those meetings can be a complete snooze.
Utilization review (UR) and case management are as traditional a team as peanut butter and jelly. But some facilities are asking whether this longtime duo is really the best combination.
Determining whether a patient should be an inpatient or on observation services can be a challenging call. If the wrong decision is made or the right decision isn't properly documented, the claim will likely be denied.
Facilities that feel they have a strong inpatient admission screening process but still have a high observation rate may need to look closely at their data.
CMS’ rules for properly applying condition code 44 are hard enough to understand, but when it comes to putting those rules into practice, things can get even more difficult.
