Registration fees for webinars are $175/member and $300/non-member unless otherwise noted in an event description.

NDHA is an approved provider of continuing education by the North Dakota Board of Examiners for Nursing Home Administrators.

2021 Utilization Planning Standards for CMS Hospital CoPs

Date: 06/03/2021

9:00 AM - 10:30 AM

This program will cover the CMS (Centers for Medicare and Medicaid Services) hospital Conditions of Participation regulations for Utilization Review. Each hospital that accepts Medicare and Medicaid reimbursement must be compliance with the UR standards to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the OIG.

Does your hospital have a contract with your state Quality Improvement Organization? Is there concise documenting in the chart regarding medical necessity and compliance with the two-midnight rule? This program will also discuss the MOON form required for outpatient observation patients revised in 2020 along with revisions to the detailed notice and IM notice.

This webinar will discuss what is typically found in a UR plan and why hospitals get cited by CMS, including examples from deficiency reports. It will cover the new website to get the CMS manuals and the new email address for sending questions directly to CMS.

Learning Objectives:

At the conclusion of this session, participants should be able to:

  • Recall that the hospital must have a Utilization Review plan.
  • Discuss the importance of the documentation of medical necessity by the physician in the medical record.
  • Describe that hospitals are required to have a Utilization Review Committee.
  • Summarize the three revised tag numbers.

Laura A. Dixon is the president of Healthcare Risk Education and Consulting. She previously served as the Director, Facility Patient Safety and Risk Management and Operations for COPIC from 2014 to 2020. In her role, Ms. Dixon provided consultation and training to facilities, practitioners and staff in multiple states.

Ms. Dixon has more than twenty years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services and pain management. Prior to joining COPIC, she served as the Director, Western Region, Patient Safety and Risk Management for The Doctors Company, Napa, California. In this capacity, she provided consultation to the physicians and staff for the western United States.

As a registered nurse and attorney, Laura holds a Bachelor of Science degree from Regis University, a Doctor of Jurisprudence degree from Drake University College of Law, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing. She is licensed to practice law in Colorado and California.

This speaker has no real or perceived conflicts of interest that relate to this presentation.