The Hospital Guide to Contemporary Utilization Review, Third Edition
The Hospital Guide to Contemporary Utilization Review, Third Edition

Author: Stefani Daniels

Publisher:

Published: 2021-10

Total Pages: 194

ISBN-13: 9781645351382

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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

The Hospital Guide to Contemporary Utilization Review
The Hospital Guide to Contemporary Utilization Review

Author: Stefani Daniels

Publisher:

Published: 2015-04-16

Total Pages: 0

ISBN-13: 9781556452147

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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

Registries for Evaluating Patient Outcomes
Registries for Evaluating Patient Outcomes

Author: Agency for Healthcare Research and Quality/AHRQ

Publisher: Government Printing Office

Published: 2014-04-01

Total Pages: 385

ISBN-13: 1587634333

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This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

CMSA Core Curriculum for Case Management
CMSA Core Curriculum for Case Management

Author:

Publisher: Lippincott Williams & Wilkins

Published: 2008

Total Pages: 666

ISBN-13: 9780781779173

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This text contains the core body of knowledge for case management practice as delineated by the Case Management Society of America (CMSA), the largest professional organization of case managers. The core curriculum provides a "synthesis of case management evolution," and presents essential elements, concepts, and vision for current and future case management practice. This edition is significantly expanded to reflect the dynamic changes taking place in case management. Each chapter is organized in a consistent format that includes learning objectives; introduction; important terms and concepts; key definitions; and references.

A Handbook for Student Nurses, third edition
A Handbook for Student Nurses, third edition

Author: Wendy Benbow

Publisher: Scion Publishing Ltd

Published: 2021-08-09

Total Pages: 228

ISBN-13: 1908625945

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A Handbook for Student Nurses is widely recommended in institutions across the UK and is essential reading for new students. The book provides an introduction to the essential background knowledge that pre-registration nursing students need as a foundation for their training. This third edition has been thoroughly revised to reflect the new NMC standards of proficiency for registered nurses and the most recent update of the NMC Code. It also features a completely new chapter on health promotion, and incorporates the very latest developments in nurse education and in the health service. A Handbook for Student Nurses covers the core of first-year nursing studies: Practice supervision and assessment Communication Legal and professional issues Values, ethics and cultural awareness Reflection and personal development Quality care and evidence-based practice Study skills Public health and promoting health and wellbeing “An excellent introductory text for student nurses, written in a clear and illuminative style.” Lecturer, Adult Nursing

Pain Management and the Opioid Epidemic
Pain Management and the Opioid Epidemic

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2017-09-28

Total Pages: 483

ISBN-13: 0309459575

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Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Fast Facts for Evidence-Based Practice
Fast Facts for Evidence-Based Practice

Author: Maryann Godshall, PhD, CNE, CCRN, CPN

Publisher: Springer Publishing Company

Published: 2009-12-07

Total Pages: 237

ISBN-13: 0826105688

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Designated a 2014 Doodyís Core Title by Doodyís Medical Reviews Concise and comprehensive, this book covers the basics of nursing research and the essentials of how to implement Evidence Based Practice (EBP). Using the short, reader-friendly, Fast Facts Series 'style,' the book is designed for those RNs studying Evidence Based Practice (EBP) who want quick access core content. Undergraduate nursing students who want a solid review of evidence based practice (& nursing research) will also find this book useful, as well as RN to BSNs student who need to assimilate content on basic nursing research. It is vital for both the practicing RNs and students to know the basics of EBP and understand how EBP can be implemented. Key features covered include: Delivery of a wide scope of EBP content in the abbreviated style of the Fast Facts series Includes coverage of quantitative and qualitative research approaches, defining the 'compelling question', finding and critiquing the evidence, and disseminating the research Unlocks the mystery surrounding systematic reviews and searching a database Class-tested content, used in seated and online course environments