Identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee with this Book! The Hospital Guide to Contemporary Utilization Review, Third Edition, 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 will help you do the following:
Identify the components of a best-practice hospital UR programDescribe the legal obligations of the hospital to comply with Chapter 42 CFR 482.30 of the CoPUse the publication as a tool to assess your own hospital’s UR processesSummarize the benefits of a dedicated UR team to promote compliance with the CoPDifferentiate between traditional Medicare and Medicare AdvantageFacilitate the development of a contemporary UR committeeDiscuss the pros and cons of the possible reporting structures for UR activitiesExamine the role of the physician advisor as a member of the UR teamRecognize the crucial role of revenue cycle in the work of the UR specialistRecommend compliant language for your organization’s UR planDescribe the components of the revenue cycle pertinent to URDifferentiate inpatient and outpatient payment rulesExplain the basics of claim preparationReview physician billing and payment rulesDifferentiate between national coverage determinations, local coverage determinations, and commercial payer criteriaSeek out operational resources to perform high-quality reviews that fully comply with the CoPExplain the connection between a good UR plan and a hospital’s revenue cycle initiatives
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