This program will cover the Centers for Medicare & Medicaid Services (CMS) hospital Conditions of Participation regulations for Utilization Review (UR). Each hospital that accepts Medicare and Medicaid reimbursement must comply with these standards. Facilities must comply with the UR standards to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the Office of Inspector General (OIG). This webinar will discuss what is typically found in a UR plan and why hospitals get cited by CMS. Information will also be provided about deficiency reports.

Learning Objectives:-

At the conclusion of this session, participants should be able to:

• Recall that the hospital must have a UR plan.
• Discuss the importance of documentation of medical necessity by the physician in the medical record.
• Explain that hospitals are required to have a UR committee.
• Describe the basics and rationale of the Medicare Outpatient Observation Notice (MOON).

Who Should Attend:-

Chief Medical Officer, Chief Nursing Officer, Compliance Officer, Emergency Department Personnel, Joint Commission Coordinator, Medical Records, Quality Improvement personnel, Risk Manager, Legal Counsel.