![]() The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on. A process for monitoring the use and delivery of services, especially one used by a managed care provider to control health care costs. What Utilization Management Is and How. Utilization Management Program. Utilization Review FAQ. I understand that many hospitals have concerns about short inpatient hospital stays (i.e., inpatient admission of a few days or less. Promotes quality and efficiency of health care delivery among purchasers, providers and patients, by establishing standards, programs of education, and communication. ![]() CFR 4. 82. 3. 0 - Condition of participation: Utilization review. The provisions of this section apply except in either of the following circumstances. A Utilization and Quality Control Quality Improvement Organization (QIO) has assumed binding review for the hospital. Prior Authorization and Quality Improvement Contracts. The purpose of the utilization review program is to safeguard against unnecessary and inappropriate medical.A UR committee consisting of two or more practitioners must carry out the UR function. At least two of the members of the committee must be doctors of medicine or osteopathy. The other members may be any of the other types of practitioners specified in . The scheduling of the periodic reviews may - . Be the same for all cases; or. Differ for different classes of cases. The hospital is not required to review an extended stay that does not exceed the outlier threshold for the diagnosis. The committee must review professional services provided, to determine medical necessity and to promote the most efficient use of available health facilities and services. ![]() ![]()
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January 2017
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