The Hospital Guide to Contemporary Utilization Review
Idioma: inglés
Editorial: Hcpro Inc, 2015
- Tapa blanda
- Usado

Librería: Sunshine State Books, Lithia, FL, Estados Unidos de AmericaSunshine State Books
Vendedor de IberLibro desde 4 de septiembre de 2013
Condición: Usado - Bueno
EUR 244,63
Cantidad disponible: 1 disponible
Añadir al carritoDescripción del artículo del vendedor
Paperback--excellent condition.
N° de ref. del artículo CL250117001G173
- Título
- The Hospital Guide to Contemporary Utilization Review
- Autor
- Stefani Daniels; Ronald L. Hirsch
- Editorial
- Hcpro Inc
- Año de publicación
- 2015
- Estado
- Very Good
- Encuadernación
- paperback
- Idioma
- inglés
- ISBN 10
- 1556452144
- ISBN 13
- 9781556452147
- Peso del artículo
- 12 onzas
- Dimensiones
- 10x8x1
Stefani Daniels, RN, MSNA, ACM, CMAC
Ronald L. Hirsch, MD, FACP, CHCQM
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
Table of Contents
Chapter 1: History of Utilization Review
- Learning Objectives
- Introduction
- Terminology: Is It Utilization Review or Utilization Management?
- History of Utilization Review
- Learning Objectives
- Healthcare Regulations
- Conditions of Participation
- Insurance Contracts
- The Regulatory Alphabet
- Learning Objectives
- Background Information
- Committee Membership
- Reporting Structure
- Utilization Review Plan Content
- The Utilization Review Committee Agenda
- Data Support
- Learning Objectives
- The Utilization Review Team
- The Utilization Review Specialist
- First-Level Reviewers
- Virtual Utilization Review
- Second-Level Reviewers
- The Physician Advisor
- Outsourced Resources
- Staffing
- Case Managers
- Residents, Hospitalists, and Private Attending Physicians
- The Revenue Cycle Team
- Learning Objectives
- Defining Medical Necessity
- Prospective Reviews for Elective Admissions
- Pre-Certification for Elective Services
- Medicare Inpatient-Only List
- Elective Medical Admissions
- Concurrent Reviews for Emergent Conditions
- The 2-Midnight Rule
- Practical Application of the 2-Midnight Rule
- Practical Application Using Screening Tools
- Other Practical Applications of the 2-Midnight Rule
- Exceptions to the 2-Midnight Rule
- Applying the 2-Midnight Rule to Transfer Patients
- Medical Documentation and the Utilization Review Process
- About Observation Services
- Continued-Stay Review
- Continued-Stay Review for Treatment of Primary Disease
- Continued-Stay Review for Additional Testing
- Determination of Proper Status
- Level of Care Within the Hospital
- Secondary Review
Chapter 6: Tools, Training, and Resources for the Utilization Review Team
- Learning Objectives
- Resources for Utilization Review Specialists
- Training and Education
- Nationally Recognized Acute Care Criteria
- Best Practice Protocols
- Regulatory Updates
- OIG Work Plan
- Commercial Contract Information
- National and Local Coverage Determinations
- Surgical and Nonsurgical Invasive Criteria
Chapter 7: Progression of Care
- Learning Objectives
- Effective Progression of Care
- Objective Outcomes
- Supplier Information
- Physician-Specific Practice Profiles
- Physician-Specific Denial Information
- Progression-of-Care Delays and Avoidable Days
- Discharge Planning and the Utilization Review Function
- Utilization Review Documentation
Chapter 8: Legal and Ethical Considerations
- Learning Objectives
- Ethical and Legal Obligations for Utilization Review
- Principles of Medical Ethics
- Legal Considerations
- Regulatory Issues Relevant to the Utilization Review Specialist
- Advance Beneficiary Notice
- Hospital Issued Notices of Non-Coverage
- Certification of Admissions
- Condition Code 44
- Self-Denial of Inpatient Admissions
Who should read this book?
- Case managers
- UR coordinators
- UR committee members
- UR physician advisors
- Nurse managers
- Revenue cycle managers
- Compliance officers and auditors
- Healthcare lawyers and consultants
“Sinopsis” puede pertenecer a otra edición de este título.
Acerca del autor
Ronald L. Hirsch, MD, FACP, CHCQM, is vice president at AccretivePAS® Clinical Solutions in Chicago. He is a general internist and HIV specialist. Dr. Hirsch was the medical director of case management at Sherman Hospital in Elgin, Illinois. He is certified in healthcare quality and management by the American Board of Quality Assurance and Utilization Review Physicians. In addition, he is a member of the American Case Management Association, a member of the American College of Physician Advisors, and a fellow of the American College of Physicians.
“Acerca de” puede pertenecer a otra edición de este título.
Sunshine State Books
Lithia, FL, Estados Unidos de America
Vendedor de IberLibro desde 4 de septiembre de 2013
Tarifas de envío en Estados Unidos de America
| Artículo | De 5 a 14 días hábiles | De 3 a 5 días hábiles |
|---|---|---|
| Primer artículo | EUR 5,41 | EUR 8,06 |
Métodos de pago
Descripción de la tienda
We are an internet bookseller doing business only through the internet. If we have made an error in your order, we accept all returns that we receive within 30 days of delivery. For orders that you want to return because you changed your mind, the book is no longer wanted, or you failed to read the description, we do not accept returns. This policy was implemented as the cost of these requests has become prohibitive. We appreciate your business.
Información empresarial del vendedor
Sunshine State Books
FL, Estados Unidos de America
Condiciones de venta
We guarantee the condition of every book as it's described on the Abebooks web sites. If you're dissatisfied with your purchase (Incorrect Book/Not as Described/Damaged) or if the order hasn't arrived, you're eligible for a refund within 30 days of the estimated delivery date. If you've changed your mind about a book that you've ordered, please use the Ask bookseller a question link to contact us and we'll respond within 2 business days.
Info required for EU:
Name: Jip Lee DBA Sunshine State Books
Address 10619 Walter Hunter Rd Lithia FL USA 33547
Phone: 813 737 1606
Email: jiplee@aol.com
Derecho al desistimiento
Si es un consumidor, puede rescindir el contrato de acuerdo con lo siguiente. Por consumidor se entiende cualquier persona física que actúe con fines ajenos a su actividad comercial, empresarial, oficio o profesión.
Información sobre el derecho de desistimiento
Derecho legal de desistimiento
Tiene derecho a rescindir este contrato en un plazo de 14 días sin dar ningún motivo.
El periodo de desistimiento vencerá a los 14 días desde que usted, o un tercero que no sea el transportista e indicado por usted, adquiera la posesión física del último bien o del último lote o pieza.
Para ejercer el derecho de desistimiento, complete de forma electrónica y envíe una declaración clara en nuestro sitio web, desde "Mis compras" en "Mi cuenta". Le enviaremos sin demora un acuse de recibo de dicho desistimiento a través de un soporte duradero (por ejemplo, por correo electrónico).
Para cumplir con el plazo de desistimiento, basta con que envíe su comunicación relativa al ejercicio del derecho de desistimiento antes de que venza el periodo de desistimiento.
Efectos del desistimiento
Si rescinde este contrato, le reembolsaremos todos los pagos que hayamos recibido de usted, incluidos los gastos de envío (excepto los gastos adicionales que surjan si elige un tipo de envío que no sea el tipo de envío estándar más económico que ofrecemos).
Podemos hacer una deducción del reembolso por la pérdida de valor de cualquier bien suministrado, si la pérdida es el resultado de una manipulación innecesaria por su parte.
Efectuaremos el reembolso sin demoras indebidas y, a más tardar, 14 días después de que se nos informe de su decisión de rescindir este contrato.
Efectuaremos el reembolso utilizando el mismo medio de pago que utilizó para la transacción inicial, a menos que haya acordado expresamente lo contrario; en cualquier caso, no incurrirá en ningún cargo como resultado de dicho reembolso.
Podremos retener el reembolso hasta que hayamos recibido los bienes o hasta que nos haya presentado una prueba de que los ha devuelto, lo que ocurra primero.
Deberá devolver los bienes o entregarlos a Sunshine State Books, Lithia, Florida, U.S.A., sin demoras indebidas y, en cualquier caso, en un plazo máximo de 14 días a partir del día en que nos comunique su desistimiento del presente contrato. El plazo se cumple si devuelve la mercancía antes de que venza el periodo de 14 días. Tendrá que asumir los gastos directos de devolución de los bienes. Usted solo es responsable de la disminución del valor de los bienes como resultado de una manipulación distinta a la necesaria para establecer la naturaleza, las características y el funcionamiento de los bienes.
Excepciones al derecho de desistimiento
El derecho de desistimiento no se aplica a lo siguiente:
- La entrega de periódicos, diarios o revistas, con la excepción de los contratos de suscripción; y
- El suministro de contenido digital que no se proporcione en un soporte tangible (por ejemplo, en un CD o DVD) si, al hacer el pedido, aceptó que podíamos empezar a entregarlo y que no podría desistir una vez iniciada la entrega.
Condiciones de envío
Shipping costs are based on books weighing 2.2 LB, or 1 KG. If your book order is heavy or oversized, we may contact you to let you know extra shipping is required.