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RESOURCE GUIDE TO CASE MANAGEMENT

RESOURCE GUIDE TO CASE MANAGEMENTO ptum Executive Health ResourcesTable of contents Pages 2 - 8 Reviewing your utilization review program Learn how to evaluate your admissions review program and recommended workflow processes Pages 9 - 12 CMS regulations and guidance Navigate short inpatient stays, audit risks, gray cases for second-level review and PEPPER reports Pages 13 - 16 Best practices Helpful tips on utilization review, documentation , physician advisor roles and case MANAGEMENT Pages 17 - 20 Additional resources CMS and contractor web sites and Optum resources to help you in your case MANAGEMENT roleThe following questions assist in

Jan 01, 2016 · Helpful tips on utilization review, documentation, physician advisor roles and case management • Pages 17 ... met medical necessity criteria for an inpatient admission or for a surgical procedure, such as spinal fusion. ... (includes care management, revenue cycle management and payer rela-tions), meeting regularly to mitigate ...

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