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Review of the Conditions 2020 : A Review of the Conditions of Participation for Utilization Review: Are you Compliant?


When Feb 25, 2020 - Feb 25, 2020
Where Online
Submission Deadline Feb 25, 2020
Categories    directors of case management   rn case managers   hospitalist

Call For Papers

Topic : A Review of the Conditions of Participation for Utilization Review: Are you Compliant?

Register :

Discount Coupon : Use this Coupon (NEW2COMPLINCE) and get (10% Off) On New Signup


The Centers for Medicare and Medicaid Services (CMS) provides us with two Conditions of Participation that apply to the work of case management professionals. These include the Conditions of Participation for Discharge Planning and the Conditions of Participation for Utilization Review. This webinar will focus on these rules as they apply to the role of utilization review. For case management departments to be compliant with these regulations, RN and social work case managers must understand these "rules of the road" for utilization review and work within their boundaries.

Areas Covered in the Session :

The differences between utilization review and utilization management
The definition of medical necessity
How to balance financial and clinical medical necessity
Compliance as it relates to utilization management
Conditions of participation for utilization review
Components of a compliant utilization review plan
Components of a compliant utilization review committee
Condition Code 44
Provider Liable

Speaker Profile :

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, providing on-site education to case management staff, and strategies for assisting health care organizations in improving their case management department's efficiency and effectiveness.

Contact Info :
Compliance Key
Email :
Phone : +1 717-208-8666

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