Mich. Admin. Code R. 325.45159 - Medical audit; utilization review; document access

Rule 159.

(1) A health facility or agency shall establish a process for medical audits of individual patient cases. Medical audits shall be conducted on a representative sample of patient cases. A medical audit is to ensure proper documentation of clinical information, continuity and coordination of patient care, and the quality and safety of medical and other health care services provided.
(2) A health facility or agency shall establish a process for utilization review of care and services on a systemic and aggregated basis. A utilization review is to ensure the provision and utilization of health care services provided in terms of cost, effectiveness, efficiency, and quality.
(3) Medical audit and utilization review documents may be accessed by the department during a survey or complaint investigation when necessary to determine compliance with the code and these rules. The department shall maintain and protect these documents in accordance with state and federal laws, including privacy laws.


Mich. Admin. Code R. 325.45159
2020 MR 4, Eff. 2/21/2020

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