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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

Jan 01, 2016 · 11. Does the UR process ensure the creation of an enduring and ... the need to work closely with case/utilization management and Physician Advisors, and the role they play in ensuring both hospital and physician regulatory compliance? 13. Is a regular analysis of the hospital’s Probe and Educate outcomes, PEPPER and other

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