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)