55 Pa. Code § 1163.475 - Responsibilities of the hospital utilization review committee
The hospital utilization review committee or its representative shall:
(1) Conduct
admission reviews under §
1163.477 (relating to admission
review requirements).
(2) Conduct
continued stay reviews under §
1163.478 (relating to continued
stay review requirements).
(3)
Conduct Medical Care Evaluation studies under §
1163.479 (relating to Medical Care
Evaluation studies).
(4) Notify the
Department's Concurrent Hospital Review Section of a recipient's assigned
initial or continued length of stay. This notification shall be done on the
form specified and in accordance with the instructions in the Manual for
Concurrent Hospital Review of Inpatient Services.
(5) Provide that the justification for a
recipient's need for admission and need for continued hospital inpatient
services be documented by the attending physician in the recipient's medical
record.
(6) Notify the Department's
Concurrent Hospital Review Section of a change in a recipient's
diagnosis.
(7) Maintain utilization
review records for a minimum of 4 years from the date of submission of the year
end cost report.
(8) Submit copies
of utilization review records and documents, medical records, certification of
days records and discharge planning information to the Department upon
request.
(9) Maintain copies of
certification of days records with the patient's medical record and with the
hospital copy of the invoice submitted for payment.
(10) Review cases that the Department has
identified as being of questionable utilization of hospital facilities or
services or that contain noncompensable services or items as listed in §
1163.455 (relating to
noncompensable services and items).
(11) Initiate discharge planning during the
admission review process to provide timely placement in an appropriate level of
care for those patients that may require posthospital care.
(12) Follow the procedures specified in the
Department's Manual for Concurrent Hospital Review of Inpatient Services in
conducting utilization review activities.
Notes
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