Download or read book The Hospital Guide to Contemporary Utilization Review written by Stefani Daniels and published by . This book was released on 2015-04-16 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations. The book covers a range of topics, including compliance with the UR Condition of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best practice hospital utilization review (UR) program Describe the legal obligations of the hospital to comply with chapter 42 CFR 482.30 of the Conditions of Participation (CoP) Use the publication as a tool to assess his or her own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Facilitate the development of a contemporary UR committee Assess an organization's opportunities to improve processes to benefit patient care and hospital success Recommend compliant language for the organization's UR plan Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives

Download or read book A Guide to Utilization Management written by Joanne Lamprey and published by . This book was released on 1987 with total page 177 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Guide to Utilization Management written by Joanne Lamprey and published by . This book was released on 1989 with total page 180 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Hospital Guide to Contemporary Utilization Review written by Stefani Daniels and published by . This book was released on 2018 with total page 141 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Hospital Guide to Contemporary Utilization Review Third Edition written by Stefani Daniels and published by . This book was released on 2021-10 with total page 194 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Hospital Guide to Contemporary Utilization Review, Third Edition, is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations in a value-based world. The book covers a range of topics, including compliance with the UR Conditions of Participation (CoP), legal obligations of a hospital, contract language, and compliant UR plan language, to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best-practice hospital UR program Describe the legal obligations of the hospital to comply with Chapter 42 CFR 482.30 of the CoP Use the publication as a tool to assess your own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Differentiate between traditional Medicare and Medicare Advantage Facilitate the development of a contemporary UR committee Discuss the pros and cons of the possible reporting structures for UR activities Examine the role of the physician advisor as a member of the UR team Recognize the crucial role of revenue cycle in the work of the UR specialist Recommend compliant language for your organization's UR plan Describe the components of the revenue cycle pertinent to UR Differentiate inpatient and outpatient payment rules Explain the basics of claim preparation Review physician billing and payment rules Differentiate between national coverage determinations, local coverage determinations, and commercial payer criteria Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good UR plan and a hospital's revenue cycle initiatives

Download or read book The Utilization Management Guide written by David Ed Reiter and published by Urac. This book was released on 2005-01-01 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book A Guide to Utilization Review written by Joanne Lamprey and published by . This book was released on 1991 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book A Complete Guide to Utilization Management written by Sharon Baschon and published by . This book was released on 1992 with total page 247 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Utilization Management Guide written by Garry Carneal and published by American Accreditation Healthcare Commission. This book was released on 2000-01-01 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Medical Utilization Review Coordinator The Comprehensive Guide written by VIRUTI SHIVAN and published by Viruti Satyan Shivan. This book was released on with total page 233 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the rapidly evolving landscape of healthcare, the role of a Medical Utilization Review Coordinator has never been more critical. This comprehensive guide is designed to navigate you through the complexities of healthcare management, ensuring efficiency, compliance, and optimal patient care. Whether you're new to the field or looking to enhance your expertise, this book offers a treasure trove of insights, strategies, and best practices. By focusing on the intersection of medical necessity, patient rights, and regulatory requirements, it prepares you to become an invaluable asset to any healthcare organization. Without relying on images or illustrations, this guide delves deep into the core responsibilities of a Medical Utilization Review Coordinator, from conducting thorough patient case reviews to navigating insurance verifications and appeals. It emphasizes the importance of evidence-based decisions, interdisciplinary collaboration, and ethical patient advocacy. This book stands out by offering real-world scenarios, expert advice, and actionable tips to excel in this demanding yet rewarding career. As the healthcare industry continues to face unprecedented challenges, equip yourself with the knowledge and skills to make a significant impact on the quality and efficiency of care provided.

Download or read book A Complete Guide to Utilization Management written by Sharon Baschon and published by . This book was released on 1990 with total page 247 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Utilization Management A Complete Guide 2020 Edition written by Gerardus Blokdyk and published by 5starcooks. This book was released on 2020-01-19 with total page 310 pages. Available in PDF, EPUB and Kindle. Book excerpt: What are the Utilization management tasks and definitions? When is/was the Utilization management start date? What are the current costs of the Utilization management process? How does your organization evaluate strategic Utilization management success? What were the criteria for evaluating a Utilization management pilot? Defining, designing, creating, and implementing a process to solve a challenge or meet an objective is the most valuable role... In EVERY group, company, organization and department. Unless you are talking a one-time, single-use project, there should be a process. Whether that process is managed and implemented by humans, AI, or a combination of the two, it needs to be designed by someone with a complex enough perspective to ask the right questions. Someone capable of asking the right questions and step back and say, 'What are we really trying to accomplish here? And is there a different way to look at it?' This Self-Assessment empowers people to do just that - whether their title is entrepreneur, manager, consultant, (Vice-)President, CxO etc... - they are the people who rule the future. They are the person who asks the right questions to make Utilization Management investments work better. This Utilization Management All-Inclusive Self-Assessment enables You to be that person. All the tools you need to an in-depth Utilization Management Self-Assessment. Featuring 947 new and updated case-based questions, organized into seven core areas of process design, this Self-Assessment will help you identify areas in which Utilization Management improvements can be made. In using the questions you will be better able to: - diagnose Utilization Management projects, initiatives, organizations, businesses and processes using accepted diagnostic standards and practices - implement evidence-based best practice strategies aligned with overall goals - integrate recent advances in Utilization Management and process design strategies into practice according to best practice guidelines Using a Self-Assessment tool known as the Utilization Management Scorecard, you will develop a clear picture of which Utilization Management areas need attention. Your purchase includes access details to the Utilization Management self-assessment dashboard download which gives you your dynamically prioritized projects-ready tool and shows your organization exactly what to do next. You will receive the following contents with New and Updated specific criteria: - The latest quick edition of the book in PDF - The latest complete edition of the book in PDF, which criteria correspond to the criteria in... - The Self-Assessment Excel Dashboard - Example pre-filled Self-Assessment Excel Dashboard to get familiar with results generation - In-depth and specific Utilization Management Checklists - Project management checklists and templates to assist with implementation INCLUDES LIFETIME SELF ASSESSMENT UPDATES Every self assessment comes with Lifetime Updates and Lifetime Free Updated Books. Lifetime Updates is an industry-first feature which allows you to receive verified self assessment updates, ensuring you always have the most accurate information at your fingertips.

Download or read book Improving Healthcare Quality in Europe Characteristics Effectiveness and Implementation of Different Strategies written by OECD and published by OECD Publishing. This book was released on 2019-10-17 with total page 447 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Download or read book An Introductory Guide to Utilization Management for Acute Care Facilities agencies written by British Columbia Health Association and published by . This book was released on 1991 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Utilization Management written by Gerardus Blokdyk and published by Createspace Independent Publishing Platform. This book was released on 2018-04-25 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: When a Utilization management manager recognizes a problem, what options are available? What other areas of the organization might benefit from the Utilization management team's improvements, knowledge, and learning? How do we manage Utilization management Knowledge Management (KM)? Do we all define Utilization management in the same way? Is Utilization management currently on schedule according to the plan? This instant Utilization management self-assessment will make you the dependable Utilization management domain auditor by revealing just what you need to know to be fluent and ready for any Utilization management challenge. How do I reduce the effort in the Utilization management work to be done to get problems solved? How can I ensure that plans of action include every Utilization management task and that every Utilization management outcome is in place? How will I save time investigating strategic and tactical options and ensuring Utilization management costs are low? How can I deliver tailored Utilization management advice instantly with structured going-forward plans? There's no better guide through these mind-expanding questions than acclaimed best-selling author Gerard Blokdyk. Blokdyk ensures all Utilization management essentials are covered, from every angle: the Utilization management self-assessment shows succinctly and clearly that what needs to be clarified to organize the required activities and processes so that Utilization management outcomes are achieved. Contains extensive criteria grounded in past and current successful projects and activities by experienced Utilization management practitioners. Their mastery, combined with the easy elegance of the self-assessment, provides its superior value to you in knowing how to ensure the outcome of any efforts in Utilization management are maximized with professional results. Your purchase includes access details to the Utilization management self-assessment dashboard download which gives you your dynamically prioritized projects-ready tool and shows you exactly what to do next. Your exclusive instant access details can be found in your book.

Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

Download or read book Managed Care Pharmacy Practice written by Navarro and published by Jones & Bartlett Publishers. This book was released on 2008-12-11 with total page 659 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.