CMS Hospital CoP UR Planning Standards 2019

Price: $ + applicable taxes

This program will cover the CMS hospital Conditions of Participation regulations for Utilization Review. Every hospital that accepts Medicare and Medicaid reimbursement must be compliance with these updated standards. Compliance with the UR standards is extremely important to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the OIG.

Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmission now receive less money from CMS. There is increased surveillance activity in the area of discharge planning due to these changes. So what's in your organization's UR plan?

Documenting regarding medical necessity and compliance with the Two Midnight Rule
MOON forms required for outpatient observation patients
Three revised tag numbers and UR committee requirements

Program Highlights

CMS UR Committee to Reduce Patient Readmissions

What to include when redrafting your discharge planning evaluation form
The 3 tag number revisions
New requirements for UR planning - guidance for providers

Utilization Review under Tag 652 & Standardized Reporting

Ensure federal compliance - changes required by CMS
The elements you must measure and what audit contractors are looking for
Last changes regarding accreditation organizations assessing compliance with UR standard

Prepare for Changes and Updates: Guidance for Hospitals, CAHs & Home Health

What information must be included in your UR plan
MOON Forms for outpatient observation patients
Review of physicians and non-physician providers

Live Question & Answer Session - Have your questions answered by the expert!

About the Speaker

Sue Dill Calloway is president of Patient Safety, Healthcare Consulting and Education company, which focuses on medical legal education especially the Joint Commission and the CMS hospital CoPs regulatory compliance. She lectures on legal, risk management and patient safety issues. She was a director for risk management and patient safety for five years for the Doctors Company. She was the past VP of Legal Services at a community hospital in addition to being the Privacy Officer and the Compliance Officer. She was a medical malpractice defense attorney for ten years.

Sue has 3 nursing degrees in addition to a law degree.
She is a well known lecturer and the first one in the country to be a certified professional in CMS.
Sue also teaches the courses for the CMS certification program. She has written over 100 books and thousands of articles

Program Benefits

It is important to establish medical necessity especially in light of the RAC program so hospitals do not owe large sums of money. This program will cover the CMS hospital Conditions of Participation regulations for Utilization Review. Every hospital that accepts Medicare and Medicaid reimbursement must be compliance with these standards. Compliance with the UR standards is more important than ever.

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