A Review of the Conditions of Participation for Utilization Review: Are you Compliant?

Topic : A Review of the Conditions of Participation for Utilization Review: Are you Compliant?

Register:https://www.compliancekey.us/webinarDetails?industryId=3&webinarid=1577&speakerid=214&source=EG_LN

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Overview

The Centers for Medicare and Medicaid Services (CMS) provides us with two Conditions of Participation that apply to the work of case management professionals. These include the Conditions of Participation for Discharge Planning and the Conditions of Participation for Utilization Review. This webinar will focus on these rules as they apply to the role of utilization review. For case management departments to be compliant with these regulations, RN and social work case managers must understand these "rules of the road" for utilization review and work within their boundaries.

Areas Covered in the Session :

• The differences between utilization review and utilization management
• The definition of medical necessity
• How to balance financial and clinical medical necessity
• Compliance as it relates to utilization management
• Conditions of participation for utilization review
• Components of a compliant utilization review plan
• Components of a compliant utilization review committee
• Condition Code 44
• Provider Liable

Speaker Profile :

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department's efficiency and effectiveness.

Contact Info :

Compliance Key

https://www.compliancekey.us/

Email : [email protected]

Phone : +1 717-208-8666