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Tip: Examine where patients come from when determining UR staff allocation

Case Management Weekly, November 10, 2010

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The initial utilization review (UR) lays the groundwork necessary to maximize the approval of admissions; therefore, the case management department should examine where patients come from. For most facilities, this means the emergency department, outpatient surgical areas, and direct admissions. For larger institutions and regional centers, transfers and clinics can add to the daily caseload. A review of volume of admissions per area can provide insight into the resources necessary for sufficient case management coverage to review admissions.

Most initial reviews take 15-20 minutes depending on the knowledge and skill set of the reviewer, the criteria used, and whether a manual paper-based assessment or software assessment is completed. Patients with complex situations, which include transfers, can take longer.

When assessing for staffing resources to be allocated, consider the time of admission, throughput, volume, and the level of the reviewer’s expertise.

This week’s tip is adapted from Prevent Denials and Win Appeals published by HCPro, Inc. For more information on this book or to order your copy, visit the HCMarketplace.

Do you have a question about a case management topic? Send it to Editor Ben Amirault at bamirault@hcpro.com. An answer to your question might appear in a future issue of Case Management Weekly.

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