2020 - Fundamentals of Utilization Management: A Review of the Conditions of Participation for Utilization Review

The differences between utilization review and utilization management
The definition of medical necessity
How to balance financial and clinical medical necessity
Compliance as it relates to utilization management
Conditions of participation for utilization review
Components of a compliant utilization review plan
Components of a compliant utilization review committee
Condition Code 44
Provider Liable
Guidelines for utilization review surveys
Guidelines for admission and continued stays
Clinical aspects affecting medical necessity
Three types of utilization management
Utilization management and access point case management
Sample utilization management reports
The two-midnight rule and utilization management
Hospital Issued Notices of Non-Coverage – HINNs
Denial management as a component of utilization management