Quality Improvement Organization Manual Chapter …

Quality Improvement Organization Manual Chapter 4 - Case Review Table Of Contents (Rev. 18, 10-10-14) Transmittals for Chapter 4 MANDATORY CASE REVIEW REQUIREMENTS 4000 - Introduction 4010 - Anti-dumping Violations 4020 - Assistants at Cataract Surgery 4030 - Beneficiary Complaints 4040 - Hospital and Medicare + Choice Organization (M+CO) Notices of Non-coverage 4050 - Hospital-requested Higher-weighted Diagnosis Related Groups (DRG) Assignments 4060 - Potential Concerns Identified During Project Data Collection (PDC) 4070 - Referrals BASIC CASE REVIEW ACTIVITIES 4100 - Introduction 4105 - Quality Review 4110 - Admission/Discharge Review 4115 - Invasive Procedure Review 4120 - Length-of-Stay Review 4125 - Coverage Review 4130 - DRG Validation Review ADDITIONAL CASE REVIEW ACTIVITIES 4200 - Introduction 4210 - Outlier Review 4230 - Limitation on Liability Determinations 4240 - Readmission Review 4250 - Transfer Review 4255 - Circumvention of Prospective Payment System (PPS)

Quality Improvement Organization Manual Chapter 4 - Case Review TABLE OF CONTENTS (Rev. 2, 07-11-03) MANDATORY CASE REVIEW REQUIREMENTS 4000 - Introduction

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