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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?
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.
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.