Learn the importance of a comprehensive Utilization Management process and the benefits including a decrease in denials, improved revenue and more.
A hospice attending physician plays the most significant role in determining the type of medical care the patient receives as well as ensuring the patient is satisfied with the hospice's quality of care.
PDGM challenges home health agencies to provide efficient and effective care in order to be successful financially while maintaining focus on delivering care that improves the patient’s functional abilities.
Hospice agencies are faced with many regulatory challenges on a daily basis, including creating, maintaining and updating patient care plans.
Many questions regarding how to monitor the effectiveness of a telehealth visit in the hospice setting and whether hospice care should be, or even can be provided in this manner have emerged.
The Utilization Review (UR) function in the emergency department (ED) serves as a critical component to ensure whether a patient is placed as inpatient or observation. Establishing the UR team to manage patient status at the point of admission is imperative to minimizing denials down the line. Too often, hospitals waste time and money by [...]
By implementing improved processes, physician and staff education, tailored operations strategies and increased admission reviews, this engagement slashed observation rates by a third. As a result of working with utilization review staff to achieve correct patient status assignments, the health system experienced a $1.8M revenue improvement in the first three months of the engagement.
Centralizing Utilization Review Functions is a cost-saving quality improvement measure, closes gap in coverage due to inter-rater reliability. Many forward-thinking organizations recognize the negative financial impact of inaccurate or non-existent UR. Learn how it's worked for a large, newly formed health system...
Based on BFCC-QIO inpatient short stay reviews, Providers could be susceptible to 25 or 10 case request based on audit area and prior audit findings.