This course will focus on the challenge of ensuring accurate patient status assignments. While it is physicians who are charged with determining patient status in the hospital, the case manager plays a critical role in helping to ensure these decisions are correct. During utilization review, case managers often review patient status, ensure it meets criteria, and identify whether documentation supports medical necessity. This course will cover how to determine whether a patient status assignment is accurate. It will also provide an overview of the elements that must be present in physician documentation to support medical necessity and patient status, and discuss the impact of the 2-midnight rule on this documentation. The course will additionally note potential challenges in complying with the 2-midnight rule and strategies to overcome them. Finally, it will outline how to create a successful audit process—one designed to find potential patient status problems—and how to form strategies to establish corrective actions that prevent future status errors.
At the completion of this course, the student will be able to: