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Utilization review (UR) activities have been around for decades. The scope of the activities run the gamut from a backward glance at physician documentation to ensure that the patient’s clinical picture and proposed interventions match the best-practice scenarios promoted by MCG and IQ, to real-time peer review by a team…
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Unabashedly, this is a teaser for an upcoming webinar "How to Outflank Capricious and Arbitrary Medical Necessity Guidelines from Payers" - a deep-dive look to the role and relevance of these two national standards for guiding a hospital’s utilization and denial management efforts.  There’s much to unpack, especially for nurses…