Many are now providing or preparing to provide more clinical services in your adult day health programs.  This is impressive and important.  Maximizing how you serve your community has value and speaks to your commitment to care along the continuum.

Generally your Medicare fiscal intermediary will arrange for your pre-certification survey via your state health department.  Among the requirements they will ensure you have met is your Utilization Review Policy.  This policy ensures the highest level of quality care with a peer review system and an ongoing review of every aspect of attention to patients in each category of service.

Generally this policy requires a review of the operation by those who are:

  1. Not involved in the development of the Patient’s Treatment Plan
  2. Not involved in the Execution  of Services to the Patient

In addition, at least one, (1) professional who is familiar with the level of care being provided would have to be involved.  A regular schedule of their meetings would ideally be published internally and posted and the methodology for communicating their recommendations regarding admissions, discharge, patient care, etc. would be established and followed.

Be sure this is an area of your certification process and operation that everyone takes seriously.  In preparing yours, study the guidelines carefully and/or seek professional guidance.  The long-term advantage for those you serve can be of immense value.

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