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CMS Hospital CoP UR Planning Standards 2020

Hitmire LLC
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Endorsed by Curators:
Jan 29 1:00PM - 4:00PM
Description:-

This program will cover the CMS (Center for Medicare and Medicaid Services) hospital Conditions of Participation regulations for Utilization Review. Every hospital that accepts Medicare and Medicaid reimbursement must be in compliance with these standards. Compliance with the UR standards is more important to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the OIG.

Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmission now receive less money from CMS. This is why there is increased surveillance activity in the area of discharge planning.

It is important to establish medical necessity especially in light of the RAC program so hospitals do not have to pay back the money. So whats in your UR plan? This webinar will discuss what is typically found in a UR plan.

This program will discuss why hospitals get cited by CMS. Information will be provided about the deficiency reports.

Does your hospital have a contract with your state QIO? Is there concise documenting in the chart regarding medical necessity and compliance with the two-midnight rule? This program will also discuss the MOON form required for outpatient observation patients.

Session Outline:-

Utilization Review

Utilization Review under Tag 652
Introduction
How to keep up with CMS changes in the future
How to locate a copy of the CMS UR Requirements
Last changes regarding accreditation organizations assessing compliance with UR standard
3 tag number revisions
CMS deficiency reports and why hospitals get cited
UR plan required
Must include a review of services provided to Medicare and Medicaid patient
Joint Commission adds UR plan and committee standard
If QIO contract, the surveyor will not assess the remainder of UR standards
UR plan requirements
Goals of a UR plan
Activities performed in UR plan
Functions of a UR committee
Choosing Wisely and Image Wisely
Conflicts of interest
Agreement with QIO
BFCC QIOs
State UR procedures
MOON Forms for outpatient observation patients
Review of physicians and non-physician providers
Composition of UR Committee
Frequency of reviews
Observation versus inpatient admission
Scope of reviews
Admissions or continued stay
Medical necessity determination
RACs and medical necessity
Non-physician determinations
The two-midnight rule (on hold)
Medical necessity
Intensity of services
Discharge screens
Documentation of the decision-making process
Moon form and changes to the IM and detailed notice


Objectives:-

Recall that the hospital must have a UR plan
Discuss the importance of documentation of medical necessity by the physician in the medical record
Describe that hospitals are required to have a UR Committee
Recall there are three revised tag numbers


Who Should Attend?

Anyone involved with the UR process or anyone who is required to comply with the standards. This could include the following:

Case Managers
Utilization Review Committee
Transitional Care Nurses
Social Workers
Discharge Planners
Chief Nursing Officer
Compliance Officer
Risk Manager
Regulatory Officer
Physician Advisor
UR Nurses
Joint Commission Coordinator
Nurse Educators
Chief Operating Officer
Chief Executive Officer
Business Office Manager
Health Information Director
Billing Office Director
Chief Medical Officer
Nurses with Direct Patient Care
All Nursing Directors and Managers
Anyone Else Involved with the UR Process

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