What is concurrent utilization review?
Concurrent Review- A method of reviewing patient care and services during a hospital stay to validate the necessity of care and to explore alternatives to inpatient care. It is also a form of utilization review that tracks the consumption of resources and the progress of patients while being treated.
What are the steps of the utilization review process?
The complete utilization review process consists of precertification, continued stay review, and transition of care.
What does a concurrent review nurse do?
By reviewing medical records and assessing medical review standards, a Concurrent Review Nurse is able to determine the overall health of the patient and evaluate treatment needs. They may also communicate with family members to further understand the state of the patient and form situational objectives.
Who performs concurrent review?
Concurrent Review – A process performed by Blue Medicare HMO and Blue Medicare PPO nurses while a patient is in the hospital to try to make sure the patient is in the most appropriate setting.
What does concurrent care mean?
Concurrent care allows you to continue to get medically necessary. treatment for your illness while you get hospice care. This means that you can get the benefits of comfort care and still receive life-prolonging treatments.
What is the difference between prospective concurrent and retrospective review for utilization review?
Prospective Review: Performed before or at the onset of treatment, on a case-by-case basis, this review is designed to eliminate unneeded services. Retrospective Review: Conducted after treatment is done, the review assess the appropriateness and efficacy of the treatment in order to provide data for future patients.
What are InterQual criteria?
InterQual® criteria are a first-level screening tool to assist in determining if the proposed services are clinically indicated and provided in the appropriate level or whether further evaluation is required. The first-level screening is done by the utilization review nurse.
What is a prospective review?
Prospective reviews include the initial review conducted prior to the start of treatment, and the initial review for treatment to a different body part.
What does it mean to concurrently and retrospectively collect data?
retrospective data collection. Concurrent collection is an activity that occurs while the patient is hospitalized or undergoing active treatment, while retrospective collection occurs after the patient has left the facility. The choice between the two is not easily made.
What is an example of concurrent care?
Concurrent care is defined as the provision of similar services “for example, more than one subsequent hospital visit “to the same patient by more than one physician on the same date.
What is CMS utilization review?
– Therapeutic appropriateness – Adverse events – Appropriate use of generic products – Incorrect duration of treatment – Utilization – Inappropriate or medically unnecessary care – Gross overuse – Abuse – Fraud
What does Concurrent review mean?
What does concurrent review mean? Review of the medical necessity of hospital or other health facility admissions, upon or within a short time following an admission, and periodic review of services provided during the course of treatment. How to pronounce concurrent review?
– Details about the claims administrator’s internal utilization review appeals process for the requesting physician, if any, and a clear statement that the internal appeals process is voluntary process that neither – The name and specialty of the reviewer or expert reviewer. – The telephone number in the United States of the reviewer or expert reviewer
What is the definition of Concurrent review?
Concurrent Review- A method of reviewing patient care and services during a hospital stay to validate the necessity of care and to explore alternatives to inpatient care. It is also a form of utilization review that tracks the consumption of resources and the progress of patients while being treated.