UM 1
Must be completed within 1 calendar day of admission using approved screening criteria (e.g., 2 MN, Xsolis, MCG, IQ).
Admission Review
What are these tools 2MN rule, Xsolis, MCG, IQ
Check Medical Necessity
How many Pods are in the SoCal UM Hub?
2
-Unexpectedly expired
-Hospice chosen in lieu of treatment
-Surgery/procedure on inpatient only list
Exceptions to the 2 Midnight Rule
Which UM Nurse delivered a baby on a train?
Gloria
Issued to inform Medicare beneficiaries of their outpatient/observation status
MOON
What is the tool used to complete a review for a patient who is identified as Self Pay or patient has no coverage?
Interqual
How many hospitals are included in the SoCal UM Hub?
16
This is Triggered when admission or continued stay clinical review is referred to the Physician Advisor (PA) by the UR RN for status determination.
Second Level Review
This UM Nurse lived in China for a year and volunteered at an orphanage.
Jennifer Kopcho
Provided at hospital’s expense; rarely used.
Not all hospitals have this as an option.
Outpatient in a Bed
Issued to inform Medicare beneficiaries of their hospital discharge appeal rights (IP Status)
IM
Bedded for treatment, assessment, & reassessment.
Physician documents anticipation of < 2 midnights.
Order written as Place in Observation.
Observation
when a Medicare FFS Inpatient order is written, but upon internal review, the patient does not meet Inpatient criteria...
Condition Code 44
This UM Nurse got married on her favorite sister's birthday. (Which is how she remembers her anniversary)
Ticity Wilding
Physician recertification of inpatient services for Medicare Fee for Service beneficiaries(Part A) is required for cases that are 20 inpatient days or more
Medicare 20 Day Recertification