Catalog Number : ngd1774
Title : CMS Utilization Review and Discharge Planning Standards
Speaker : Sue Dill

Webplay Recording Date : 2-4-2013
Webplay Price : $ 125 for two weeks viewing

Webinar Description:

This program will cover the CMS (Center for Medicare and Medicaid Services) hospital Conditions of Participation regulations on Utilization Review and Discharge Planning. Every hospital that accepts Medicare and Medicaid reimbursement must be compliance with these standards.

Preventing unnecessary readmissions is essential. Hospitals that have a higher rate of readmissions now receive less money from CMS which started October 2012. In fact, hospitals forfeited 280 million dollars because of having higher than expected readmission. This is why there will be increased surveillance activity in the area of discharge planning.

Target Audience:

• Utilization review committee, transitional care nurses, social workers, discharge planners, chief nursing officer, compliance officer, risk manager, social workers, regulatory officer, physician advisor, UR nurses, compliance officer, Joint Commission coordinator, nurse educators, chief operating officer, chief executive officer, business office manager, health information director, billing office director, chief medical officer, nurse educator and anyone else involved with the UR process or discharge planning. Any person serving on a hospital committee to redesign the discharge process to prevent unnecessary readmissions should also attend

Webinar Objectives:

• Discuss that the Joint Commission has changed their leadership standards to require a UR plan and UR committee
• Discuss that one in every five Medicare patients is readmitted within 30 days of discharge and many suffer adverse events
• Describe recommendations for hospitals to reduce unnecessary readmissions
• Discuss that CMS recommends that the discharge planning team use a checklist to make transfers more efficient

Webinar Agenda:

Utilization Review

• Utilization Review under Tag 652
• Introduction • UR plan required
• Joint Commission adds UR plan and committee standard
• UR plan requirements
• Goals of a UR plan
• Activities performed in UR plan
• Functions of a UR committee
• Conflicts of interest
• Agreement with QIO
• State UR procedures
• Composition of UR Committee
• Frequency of reviews
• Observation verses inpatient admission
• Scope of reviews
• Admissions or continued stay
• Medical necessity determination
• RACs and medical necessity
• Non-physician determinations

Discharge Planning

• CMS revised work sheet on discharge planning
• Discharge planning under tag 800
• Discharge planning process
• Written P&P required
• Preventing unnecessary readmission
• Federal law changes related to readmissions
• Identification of patients who need discharge planning
• Discharge planning evaluation
• Social worker, RN or qualified person required
• Self care evaluation
• List of community based services
• Document in medical record list of HHA and LTC given
• IM Notice requirements
• Detailed notice requirements
• Timely discharge evaluation
• Transfers or referrals
• EMTALA issue
• Plan of care
• Things hospitals can do to reduce unnecessary readmissions
• Third revised CMS worksheet on discharge planning
• Discharge summary in hands of PCP before first visit

Contact Hours:

• Nursing participants: Instruct-online has approved this program for 1.8 contact hours, Iowa Board of Nursing Approved Provider Number 339.
• All other participants: Must attend the entire Webinar and complete a Webinar critique to receive a 1.5 Hour Attendance Certificate for each program.

Completion of offering required prior to awarding certificate.

Full tuition is refunded immediately on request if the participant has not been sent the program materials and instructions. Once the instructions (including access codes) have been sent, a full refund will be issued only after the program runs and it is verified that the participant did not access the program.