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Utilization Review
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Book Synopsis The Hospital Guide to Contemporary Utilization Review, Third Edition by : Stefani Daniels
Download or read book The Hospital Guide to Contemporary Utilization Review, Third Edition written by Stefani Daniels and published by . This book was released on 2021-10 with total page 194 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Hospital Guide to Contemporary Utilization Review, Third Edition, 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 in a value-based world. The book covers a range of topics, including compliance with the UR Conditions of Participation (CoP), 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 UR program Describe the legal obligations of the hospital to comply with Chapter 42 CFR 482.30 of the CoP Use the publication as a tool to assess your own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Differentiate between traditional Medicare and Medicare Advantage Facilitate the development of a contemporary UR committee Discuss the pros and cons of the possible reporting structures for UR activities Examine the role of the physician advisor as a member of the UR team Recognize the crucial role of revenue cycle in the work of the UR specialist Recommend compliant language for your organization's UR plan Describe the components of the revenue cycle pertinent to UR Differentiate inpatient and outpatient payment rules Explain the basics of claim preparation Review physician billing and payment rules Differentiate between national coverage determinations, local coverage determinations, and commercial payer criteria Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good UR plan and a hospital's revenue cycle initiatives
Book Synopsis Controlling Costs and Changing Patient Care? by : Institute of Medicine
Download or read book Controlling Costs and Changing Patient Care? written by Institute of Medicine and published by National Academies Press. This book was released on 1989-01-01 with total page 321 pages. Available in PDF, EPUB and Kindle. Book excerpt: Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.
Book Synopsis Drug Utilization Research by : Monique Elseviers
Download or read book Drug Utilization Research written by Monique Elseviers and published by John Wiley & Sons. This book was released on 2016-05-31 with total page 548 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drug Utilization Research (DUR) is an eclectic scientific discipline, integrating descriptive and analytical methods for the quantification, understanding and evaluation of the processes of prescribing, dispensing and consumption of medicines and for the testing of interventions to enhance the quality of these processes. The discipline is closely related and linked mainly to the broader field of pharmacoepidemiology, but also to health outcomes research, pharmacovigilance and health economics. Drug Utilization Research is a unique, practical guide to the assessment and evaluation of prescribing practices and to interventions to improve the use of medicines in populations. Edited by an international expert team from the International Society for Pharmacoepidemiology (ISPE), DUR is the only title to cover both the methodology and applications of drug utilization research and covers areas such as health policy, specific populations, therapeutics and adherence.
Book Synopsis Managed Care Pharmacy Practice by : Navarro
Download or read book Managed Care Pharmacy Practice written by Navarro and published by Jones & Bartlett Publishers. This book was released on 2008-12-11 with total page 659 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed Care Pharmacy Practice, Second Edition offers information critical to the development and operation of a managed care pharmacy program. The text also covers the changes that have taken place within the delivery of pharmacy services, as well as the evolving role of pharmacists.
Book Synopsis Utilization Review by : United States. General Accounting Office
Download or read book Utilization Review written by United States. General Accounting Office and published by . This book was released on 1992 with total page 100 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Essentials of Utilization-Focused Evaluation by : Michael Quinn Patton
Download or read book Essentials of Utilization-Focused Evaluation written by Michael Quinn Patton and published by SAGE Publications. This book was released on 2011-08-22 with total page 489 pages. Available in PDF, EPUB and Kindle. Book excerpt: Based on Michael Quinn Patton's best-selling Utilization-Focused Evaluation, this briefer book provides an overall framework and essential checklist steps for designing and conducting evaluations that actually get used. The new material and innovative graphics present the utilization-focused evaluation process as a complex adaptive system, incorporating current understandings about systems thinking and complexity concepts. The book integrates theory and practice, is based on both research and professional experience, and offers new case examples and cartoons with Patton's signature humor.
Book Synopsis Interim Hearing on Utilization Review by : California. Legislature. Senate. Committee on Judiciary
Download or read book Interim Hearing on Utilization Review written by California. Legislature. Senate. Committee on Judiciary and published by . This book was released on 1985 with total page 124 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :United States. Congress. Senate. Committee on Finance. Subcommittee on Health Publisher : ISBN 13 : Total Pages :232 pages Book Rating :4.:/5 (327 download)
Book Synopsis Proposed Phaseout of PSRO's and Utilization Review Requirements by : United States. Congress. Senate. Committee on Finance. Subcommittee on Health
Download or read book Proposed Phaseout of PSRO's and Utilization Review Requirements written by United States. Congress. Senate. Committee on Finance. Subcommittee on Health and published by . This book was released on 1981 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Utilization Management in the Clinical Laboratory and Other Ancillary Services by : Kent Lewandrowski
Download or read book Utilization Management in the Clinical Laboratory and Other Ancillary Services written by Kent Lewandrowski and published by Springer. This book was released on 2016-11-29 with total page 303 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is the first comprehensive text on utilization management in the clinical laboratory and other ancillary services. It provides a detailed overview on how to establish a successful utilization management program, focusing on such issues as leadership, governance, informatics, and application of utilization management tools. The volume also describes ways to establish utilization management programs for multiple specialties, including anatomic pathology and cytology, hematology, radiology, clinical chemistry, and genetic testing among other specialties. Numerous examples of specific utilization management initiatives are also described that can be imported to other heath care organizations. A chapter on utilization management in Canada is also included. Edited by an established national leader in utilization management, Utilization Management in the Clinical Laboratory and Other Ancillary Services is a valuable resource for physicians, pathologists, laboratory directors, hospital administrators, and medical insurance professionals looking to implement a utilization management program.
Author :United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services Publisher : ISBN 13 : Total Pages :376 pages Book Rating :4.0/5 ( download)
Book Synopsis Drug Utilization Review by : United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services
Download or read book Drug Utilization Review written by United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services and published by . This book was released on 1989 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Hospital Utilization Review and Medicare by : Rona Beth Schumer
Download or read book Hospital Utilization Review and Medicare written by Rona Beth Schumer and published by . This book was released on 1971 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Surveillance and Utilization Review in the Medicaid Program by : United States. Health Care Financing Administration
Download or read book Surveillance and Utilization Review in the Medicaid Program written by United States. Health Care Financing Administration and published by . This book was released on 1989 with total page 538 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Author :United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services Publisher : ISBN 13 : Total Pages :388 pages Book Rating :4.0/5 (18 download)
Book Synopsis Drug Utilization Review: is HCFA Following Congressional Intent? by : United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services
Download or read book Drug Utilization Review: is HCFA Following Congressional Intent? written by United States. Congress. House. Select Committee on Aging. Subcommittee on Human Services and published by . This book was released on 1989 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Utilization-Focused Evaluation by : Michael Quinn Patton
Download or read book Utilization-Focused Evaluation written by Michael Quinn Patton and published by SAGE Publications, Incorporated. This book was released on 1986 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt: The second edition of Patton's classic text retains the practical advice, based on empirical observation and evaluation theory, of the original. It shows how to conduct an evaluation, from beginning to end, in a way that will be useful -- and actually used. Patton believes that evaluation epitomizes the challenges of producing and using information in the information age. His latest book includes new stories, new examples, new research findings, and more of Patton's evaluation humour. He adds to the original book's insights and analyses of the changes in evaluation during the past decade, including: the emergence of evaluation as a field of professional practice; articulation of standards for evaluation; a methodological synthesis of the qualitative versus quantitative debate; the tremendous growth of 'in-house' evaluations; and the cross-cultural development of evaluation as a profession. This edition also incorporates the considerable research done on utilization during the last ten years. Patton integrates diverse findings into a coherent framework which includes: articulation of utilization-focused evaluation premises; examination of the stakeholder assumption; and clarification of the meaning of utilization. --Publisher description.
Author :American Psychiatric Association. Committee on Managed Care Publisher :American Psychiatric Pub ISBN 13 :9780890422359 Total Pages :84 pages Book Rating :4.4/5 (223 download)
Book Synopsis Utilization Management by : American Psychiatric Association. Committee on Managed Care
Download or read book Utilization Management written by American Psychiatric Association. Committee on Managed Care and published by American Psychiatric Pub. This book was released on 1992-01-01 with total page 84 pages. Available in PDF, EPUB and Kindle. Book excerpt: This handbook provides clinicians with timely and useful information that will help psychiatrists obtain optimal coverage of services for patients. Among the issues addressed are frequently encountered problems, confidentiality, contracting, and the process of utilization management.
Author :National Academies of Sciences, Engineering, and Medicine Publisher :National Academies Press ISBN 13 :030946921X Total Pages :161 pages Book Rating :4.3/5 (94 download)
Book Synopsis Health-Care Utilization as a Proxy in Disability Determination by : National Academies of Sciences, Engineering, and Medicine
Download or read book Health-Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Book Synopsis Case Management by : Suzanne K. Powell
Download or read book Case Management written by Suzanne K. Powell and published by Lippincott Williams & Wilkins. This book was released on 2000 with total page 548 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Second Edition of this comprehensive "how to" text has been completely revised and updated. This text outlines the basics of case management and illustrates some of the pitfalls encountered in the field of case management. The book provides information on the new Case Management Standards, supplies standard definitions and guidelines of case management for the practicing case manager, and presents information on caring for clients in a wide variety of health care settings. New to this edition--chapters focusing on Quality Reviews and Risk Management with a strong emphasis on Continuous Quality Improvement (CQI), ethical and legal issues, and various case studies.
