Q&A: Frequency of UR Patient Status Checks

Q. Is it sufficient for utilization review (UR) to check patient status just once after admission?

A. UR does not end upon admission but is an ongoing activity that verifies appropriate admission status until discharge. Case management and the physician advisor lead this function with daily reviews of each patient. The concurrent stay reviews include discharge planning and validating the correct discharge status; therefore, if this function is performed, the coding and billing department will be able to code the discharge correctly. Nursing should be a part of the daily review to provide information on the patient’s progress and condition. Educating nursing on their part in the revenue cycle will add context to the nurse’s role and form a better team with other stakeholders. Case management and the physician advisor are good resources for nursing education.

For more information, see The Revenue Integrity Training Toolkit.

Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.