Download or read book Utilization Review Software written by Kimberly Annette Frazier and published by . This book was released on 2014 with total page 92 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Center for Medicare and Medicaid (CMS) seeks to achieve cost control by implementing aggressive cost containment mechanisms for an exploding Medicare population. One such mechanism is utilization review, which is employed to limit reimbursement of medical care that is determined to not be medically necessary. The CMS Conditions of Participation mandate that all hospitals determine whether a patient qualifies for an Inpatient or Observation stay. Utilization Review Specialist (UR) nurses were given the Conditions of Work Effectiveness Questionnaire II (CWEQ-II), Organizational Relationship Scale II (ORS-II), and the Job Activity Scale II (JAS II), six months after McKesson InterQual software was installed. The CWEQ-II resulted in the following scores: Opportunity x = 0.83, Information x = 0.71, Support x = 0.91, Resources x = 0.42. Descriptive statistics revealed that the UR nurses perceive themselves to be moderately empowered as measured by the CWEQ-II total score of 14.92 (SD + 1.23). The Net Present Value was calculated as $1,619,677.93 over a four-year span. Medical necessity denials have increased significantly over the past several years and continue to place hospitals in financial jeopardy. By providing employees with appropriate computer software programs, hospitals can mitigate the monetary damages associated with this particular denial and recoupment, and improve nurse satisfaction and commitment. Empowering work conditions for specialty nurses have positive effects on organizational attitudes and behaviors.
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 Drug Utilization Review written by United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services and published by . This book was released on 1989 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Competency Evaluation Tools for Case Management Professionals Second Edition written by Karen S. Zander and published by HC Pro, Inc.. This book was released on 2009-09-15 with total page 153 pages. Available in PDF, EPUB and Kindle. Book excerpt: This essential toolkit for case management professionals focuses on real-world case management functions, providing compentency evaluation tools designed by experts in the field and best practices for those who develop performance appraisals, job descriptions, and sequence training.
Download or read book Pharmacy Management Software for Pharmacy Technicians A Worktext E Book written by DAA Enterprises, Inc. and published by Elsevier Health Sciences. This book was released on 2017-09-13 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt: Acquire the skills to succeed in the pharmacy, before leaving the classroom, with Pharmacy Management Software for Pharmacy Technicians, 3rd Edition. This innovative software/worktext incorporates the full version of DAA Enterprises' Visual Superscript pharmacy management software to give you hands-on training performing the day-to-day tasks of a pharmacy technician — just as you will on the job. Expanded lab content, an updated drug database, and correlation with ASHP standards provide you with a comprehensive, current product to get you practice ready Easy-to-follow, step-by-step instructions guide you through essential functions in community and institutional pharmacy practice. - UNIQUE! Full version of DAA Enterprises' Visual Superscript pharmacy management software reflects the practice management programs you will encounter in the workforce — and enables you to work through realistic practice scenarios. - UNIQUE! Fully functional patient record database corresponds to work text exercises to provide realistic practice: - Adding new patients - Determining possible adverse reactions - Filling and refilling prescriptions - Examining a patient's prescription history - Identifying potential allergic reactions to drug ingredients - and much more - Worktext activities and case studies walk you through essential pharmacy tasks just as you will perform them on the job. - UNIQUE! Institutional pharmacy coverage provides additional practice in: - Extemporaneous compounding - Total parenteral nutrition - IV label preparation - Detailed screenshots, lab tips, and hints guide you through the pharmacy management software. - Study tools on the companion Evolve website provide technical support, laboratory tips, and additional practice.
Download or read book Medicare written by Institute of Medicine and published by National Academies Press. This book was released on 1990-02-01 with total page 472 pages. Available in PDF, EPUB and Kindle. Book excerpt: Volume II of Medicare: A Strategy for Quality Assurance provides extensive source materials on quality assurance, including results of focus groups with the elderly and practicing physicians, findings from public hearings on quality of care for the elderly, and many exhibits from site visits and the literature on quality measurements and assurance tools. The current Medicare peer review organization program and related hospital accreditation efforts are comprehensively described as background for the recommendations in Volume I of this report. Like the companion volume, this substantial book will be a valuable reference document for all groups concerned with quality of health care and the elderly.
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.
Download or read book Journal written by and published by . This book was released on 1988 with total page 864 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Drug Utilization Review is HCFA Following Congressional Intent written by United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services and published by . This book was released on 1989 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Research Activities written by and published by . This book was released on 2003 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Utilization Review written by United States. General Accounting Office and published by . This book was released on 1992 with total page 100 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Utilization Review written by National League for Nursing. Committee to Study Utilization Review Process and published by . This book was released on 1973 with total page 25 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 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 VA s Medical Care Collection Fund written by United States. Congress. House. Committee on Veterans' Affairs. Subcommittee on Oversight and Investigations and published by . This book was released on 2002 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book National Directory of Health Plans and Utilization Review Organizations written by and published by . This book was released on 1997 with total page 476 pages. Available in PDF, EPUB and Kindle. Book excerpt:
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 Status Report written by and published by . This book was released on 1992 with total page 334 pages. Available in PDF, EPUB and Kindle. Book excerpt:
