Key Points &
Admission Reviews
Admission Reviews
Admission IP reviews are set out __ days, __________ the day of admission.
4, including
How often are OBS/OPB cases reviewed?
Daily
CS IP reviews are set out __ days, _____ _____________ the day of the CS review.
4, not including
If there's an issue that needs to be addressed over the weekend on a CS review, change the UM status to _______________.
"weekend," to alert the weekend UR team the case needs to be reviewed.
For patients with transition delays, social admissions, or IPAS has determined that patient ______________ medical necessity, any change in status or condition is monitored per the ______ URPG.
does not meet; RR
Follow the guidelines in the URPG to determine what?
date of the next review
When are OBS/OPB cases NOT reviewed daily?
When a transition delay is identified, and the reviewer follows the RR URPG.
If a CS review is due on a Monday and met criteria, the next review is due on ____________.
Friday
What patients are set to the correct day, including weekends and holidays?
delivered maternity patients
RR cases are checked every _________, depending on the clinical situation, unless approved by the Manager for additional time.
1-3 days
When is a review performed sooner than what is stated in the URPG?
If the UR CM feels it needs to be monitored closely
At what level should you attempt to meet a patient for Episode Day 1?
Acute or higher
Continued Stay reviews are not scheduled over the weekend or _______________________.
Intermountain designated holidays.
Who can direct the date of the next review?
IPAS
If the patients condition changes, follow the _______ URPG.
RR
Where is the rationale for the NRD documented?
in the review comment
If a procedure is designated as Outpatient, which subset should you apply?
General Medical or other medical subset criteria
If a scheduled CS review falls on a weekend or holiday, when is the next CS review done?
On the following workday, Monday
For holidays without UR coverage: UR CMs should set daily ___________ and ___________ reviews out to the holiday.
OBS/OPB ; NICU/SCN
What 4 types of patients are reviewed weekly for change in condition?
GIP hospice, respite hospice, organ donation or IPAS has determined they meet med nec and don't need to be reviewed again by IPAS