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Monday, April 30, 2012
  Clinical Accuracy Spoken Here  

UM Scope of Services

The ACMA describes case management activities through scope of services descriptions including those for UM.

  • Avoidable delay identification, intervention and tracking
  • Utilization review
  • Pre-Admission planning
  • Third party payer communication
  • Level of care appropriateness coordination
  • Admission status determination
  • Clinical denial prevention

[Reference: UM, Module A, Standards and Regulations in UM]
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  Excellence in Case Mgmt  

Quality Care is Cost Effective

Successful UM balances quality care with cost-effective care in a way that benefits both the patient and the facility.

Quality care is cost effective care. Well-planned and implemented UM can enhance the hospital's revenue cycle.

[Reference: UM, Module B, Payers, Contracting and UM]
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  Improving Patient Care...  

Patient Focused UM Adds Value

The HCM tracks the activities of the interdisciplinary team members, advocates for the patient and monitors for over-utilization or under-utilization of resources.

As the only member of the healthcare team familiar with the total picture of the patient's care program, the HCM is in the best position to facilitate and coordinate the patient's care activities and utilization of resources.

By having HCMs who are patient focused, the UM team is able to deliver substantially greater value from their medical management programs and services.

[Reference: UM, Module C, Quality of Care and UM]
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Tom RasmussenTom Rasmussen
Publisher
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Tom.Rasmussen@AthenaForum.com

 
 

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Cathy WrightCathy Wright, BSN, RN
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