The rising cost of healthcare is one of the most significant issues in the world today. For far too many people, life-saving treatment is getting further out of reach. Conversely, hospitals also need help managing their costs and staying profitable. The answer to this dilemma is utilization management (UM). With UM, hospitals can manage their resources much more effectively while helping patients get their claims approved by their insurance providers.
Utilization management (UM) is a complex process that improves healthcare quality, reduces costs, and improves the population's overall health. Utilization management (UM) is a process that evaluates the efficiency, appropriateness, and medical necessity of the treatments, services, procedures, and facilities provided to patients on a case-by-case basis.
Utilization management also needs approval from several state and federal agencies, including Medicare. In addition, to integrate with various insurance companies and conform to their rules and regulations.
In this Webinar, you will discover ways to make your utilization management process more efficient. You'll also gain an understanding of the Conditions of Participation for Utilization Review and how they impact your role as a case manager. We'll explore the distinctions between utilization review and utilization management. You'll learn how to integrate medical necessity into the utilization management process, then explain the compliance aspects of utilization review, including the utilization management plan, the utilization management committee, Condition Code 44, and the two-midnight rule.
We'll show you how to include the two-midnight rule in your utilization management procedures and discuss the different types of clinical reviews that case managers perform.
You'll assess the effectiveness and compliance of your utilization management committee.
We'll describe the various types of Hospital-Issued Notices of Noncoverage (HINNs) and provide examples of how they are used.
Utilization Management Rules and Regulations:
Areas Covered:
Why Should You Attend:
The Webinar will streamline your utilization management process and help you understand the Conditions of Participation for Utilization Review and how they impact your work as a case manager. The Webinar will discuss the differences between utilization review and utilization management. Incorporating medical necessity into the utilization management process will be explained. This will be followed by examining the compliance components for utilization review, including the utilization management plan, the utilization management committee, Condition Code 44, and the two-midnight rule.
Who Should Attend:
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