103 E. State St. Alliance, OH 44601
Phone: 330-821-7616
Fax: 330-821-8009
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TATCI CE Credits

Assessing the Design, Content and Documentation of Your Utilization Review Process

for Part A Medicare

October 1, 2019 began a new Part A payment process which requires the skilled facilities to use new criteria and data to establish Medicare skilled benefit at the time of Admission. The reliance of the facility on therapy delivery and outcome data along with ADL scores is no longer a factor. Medicare payment is now influenced by a very diverse elder specific calculation from a large data base on the Admission or IPA Assessment. Facilities are required to review Part A Medicare cases during the stay to establish the continued need for skilled nursing or skilled rehabilitation. This session will review the five areas of data that create payment levels and the skilled definition in the Medicare Benefit Policy Manual. Review of these items from the MDS data base makes the utilization process more complex and very interdisciplinary. Case examples and a meeting formats will be discussed as well as newly revised eligibility and skilled criteria definitions. Records of UR meetings are very important and a review of the formats will be part of the program.


1. Review the changes in the U.R. process precipitated by the implementation of the PDPM payment system.

2. Discuss compliance audit and issues related to the U.R. activity and regulatory standards.

3. Describe the structure of the interdisciplinary U.R. process vs. the therapy U.R. process.

4. Review the record keeping requirements for the Utilization Review process.

5. Discuss the use of utilization data for outcome documentation.

When: November 16, 2021   9:00 a.m.- 4:30 p.m.

Where: The Alliance Training Center 1930 S. Freedom Ave., Ste. B

Alliance Oh 44601

(330) 821-7616

Instructor: Leah Klusch, RN, BSN, FACHCA

Cost: $125 per person

NAB Approved for 6 hours

Call today to register! (330) 821-7616