In this jam-packed program you will learn how to stream-line your utilization management process as well as understand the conditions of participation for utilization review and how they impact your work as a case manager. Differences between utilization review and utilization management will be discussed.
The process for incorporating medical necessity into the process of utilization management will be explained followed by a discussion of the compliance components for utilization review including the utilization management plan, the utilization management committee, Condition Code 44 and the two-midnight rule. Also the various types of clinical reviews performed by the case manager and how to incorporate the two midnight rule into your utilization management process will be explained. You will learn whether or not your utilization management committee is effective and compliant.
The various types of Hospital-Issued Notices of Non-Coverage (HINNs) will be described with examples of how they are used. You will learn strategies for passing a survey on the Conditions of Examples of utilization review committee reports will round out this comprehensive program.
Why Should You Attend?
Utilization management is one of the fundamental roles of the hospital case manager and as such each RN case manager should be aware of the rules of utilization as put out by the Centers for Medicare and Medicaid Services (CMS) as well as how utilization management relates to value-based reimbursement. Stay current on this topic and have a chance to review forms and other processes you need to be at the top of your game.
Who Should Attend?
|Live + Recorded||$ 323.00|
|Live + DVD||$ 333.00|
|Live + Transcript||$ 323.00|
|Recorded + Transcript||$ 323.00|
|DVD + Recorded||$ 333.00|
|DVD + Transcript||$ 333.00|
|Live 1 to 3||$ 493.00|
|Live 1 to 6||$ 693.00|
Get coins in your wallet on every purchase by registering with us and you can redeem your coins in your next purchase.