Case Management

Tips: Evaluate medical necessity early

Case Management Weekly, May 4, 2011

An effective process for evaluating medical necessity of admission begins when a patient presents to the emergency department or physician’s office, or when a procedure appears on the surgery schedule. Addressing medical necessity at these times helps hospitals avoid the burdensome process of changing the level of care order, particularly when an order for inpatient status must be changed to an outpatient order.

This week’s tip is adapted from Observation Services: A Guide to Compliant Level of Care Determinations published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace

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

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