Utilization Review and Case Management


1. What type is your hospital? *


2. How many licensed beds? *


3. What is your Average Daily Census (ADC)


4. What is your EMR?


5. Describe your Care Management Department: *


6. Describe your reporting structure: *


7. Do you have 7 day/week coverage for Utilization Review? *


8. Do you have 7 day/week coverage for Case Management? *


9. Approximately how many hours a day is there coverage for your UR Team? *


10. Approximately how many hours a day is there coverage for your CM Team? *


11. Describe your UR working process: *


12. Describe your CM working process: *


13. Does your department have a system or role for complex care management? *


14. What type of protocol does your CM department utilize? *


15. Does your department utilize CM supportive services? *


16. Are there dedicated CM Staff in the ED? *


17. How would you describe your UR staff's relationship with Physicians? *


18. How would you describe your CM staff's relationship with Physicians? *


19. Does your CM team participate in contract negotiations with payers? *


20. What criteria do you use for your First Level Review? (May check more than one answer) *


21. Do you perform First Level Reviews for 100% of your patients? *


22. If the answer to #20 was "no", what percent of the total get First Level Reviews?


23. What Level of Care criteria do you consistently apply? (May be more than one answer) *


24. What do you do when the patient does not meet IP criteria? *


25. Who performs the Second Level Review for you? *


26. How many Condition Code 44's do you have monthly? *


27. Do you utilize Condition Code W-2? *


28. Do you utilize Condition Code Span 72? *


29. Do you follow the 2 Midnight Rule? *


30. Do you believe that 2 MN equals IP? *


31. Do you have a UR Committee? *


32. How often does your UR Committee meet? *


33. How would you describe your UR Committee? *


34. Has there been any integration of your UR/CM department with other departments such as CDI, or coding? *


35. What is your OBS/CDU patient process? *


36. Optional:
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If you request your score, there will be three categories, one of which you will fall into with options for follow-up and discussion.


37. In addition, and it is voluntary, would you please provide the following information to help determine if further conversations may occur:


38. Which report would you like to receive? (May check more than one category)