28 Pa. Code § 107.53 - Utilization review

The hospital shall have a written plan for utilization review approved by the medical staff, administration, and governing body which generates reports adequate enough to permit identification of patient care problems. The plan shall establish a system to use this data to document appropriate utilization which shall include at least the following:

(1) A description of the method for evaluating the appropriateness and medical necessity of admissions, continued stays, and supportive services as well as delays in the provision of supportive services.

(2) The procedures for conducting concurrent review, including the time period within which the review is to be initiated following admission and the length of stay norms and percentiles to be used in assigning continued stay review dates. Records of the findings shall be maintained and reported, according to established mechanisms, to the executive committee of the medical staff and to the governing body.

Notes

28 Pa. Code § 107.53

The provisions of this § 107.53 amended September 19, 1980, effective 9/20/1980, 10 Pa.B. 3761.

The provisions of this § 107.53 issued under 67 Pa.C.S. §§ 6101-6104; and Reorganization Plan No. 2 of 1973 (71 P. S. § 755-2).