Iowa Admin. Code r. 655-12.6 - Scope of review
(1)
Factors to determine appropriateness of nursing care deemed medically necessary
may include but are not limited to:
a.
Utilization of the nursing process in establishing a nursing
diagnosis.
b. Development of a
nursing care plan based on documentation of client needs and standards of care
for that particular clinical specialty.
c. Adequate completion of recommended nursing
care plan.
d. Quality of care as
measured by outcome.
e. Proper
referral to specialists or physicians when conditions indicate.
(2) Cost review will result in an
opinion as to the fairness of charges for nursing care services based on
criteria including but not be limited to:
a.
The nurse's usual charge for the service.
b. The customary charge for the service based
on a review of peer group charges.
c. Reasonable variance due to degree of
difficulty, skill, or judgment.
Notes
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(1) Factors to determine appropriateness of nursing care deemed medically necessary shall include, but not be limited to, the following:
a. Utilization of the nursing process in establishing a nursing diagnosis.
b. Development of a nursing care plan based on documentation of client needs and standards of care for that particular clinical specialty.
c. Adequate completion of recommended nursing care plan.
d. Quality of care as measured by outcome.
e. Proper referral to specialists/physicians when conditions indicate.
(2) Cost review shall result in an opinion as to the fairness of charges for nursing care services based on criteria which shall include, but not be limited to, the following:
a. The nurse's usual charge for the service.
b. The customary charge for the service based on a review of peer group charges.
c. Reasonable variance due to degree of difficulty factors which require extraordinary skill and judgment.