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  • UR and Medical Necessity

    This article was recently posted by Glenn Kraus on HCPRO's CASE MANGEMENT WEEKLY. With his permission, it is essential reading for HCM leaders. It highlights the reasons why the UR function can no longer be an 'add on' activity to the hospital case managers' role.  Executives lax attention to the issues surrounding 'medical necessity' is no longer realistic if the hospital wants to financially thrive.
  • Laying the Foundation

    Designing and executing a clinical resource management program is not easy.  It’s not so much that any one part of the program is difficult to design and implement.  Rather, it’s the combination of all the parts that becomes untenable.

     
  • What gets Measured gets managed!

    When we started this newsletter back in 1994, we reported the difficulties in obtaining information about payer denials.  Hospitals simply could not provide actionable information to identify the source of their denials...
  • The Business Case for Hospital Case Management

    When case management was introduced in hospitals in the mid 80s, it was accompanied by a promise to control costs at the bedside.

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UR and Medical Necessity

This article was recently posted by Glenn Kraus on HCPRO's CASE MANGEMENT WEEKLY. With his permission, it is essential reading for HCM leaders. It highlights the reasons why the UR function can no longer be an 'add on' activity to the hospital case managers' role.  Executives lax attention to the issues surrounding 'medical necessity' is no longer realistic if the hospital wants to financially thrive.


REFLECTIONS

Welcome to the March issue of REFLECTIONS which includes some thoughts about defining hospital case management in terms of utilization review. Its time to change the conversation and return to case management practice. We also call your attention to the 2012 OIG work plan which will review observation patterns and the recent change in how active monitoring hours can be streamlined. As always, we welcome your comments and thoughts.

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