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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 evaluating current medical necessity admission review programs and provide a checklist for ongoing evaluation of program effectiveness.

Jan 01, 2016 · 5. Is the medical necessity admission review process in effect 7 days per week, 365 days per year? 6. Is there ongoing training and education available for case/utilization management and Physician Advisor teams? 7. Is there inter-rater reliability testing and quality assurance of case/ utilization management? 8.

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