Quality Utilization Management

Features And Functions Include:

• Monitors user-defined quality criteria and indicators.
• Compliance/non-compliance is entered in user-defined format.
• Pre-admission, admission, continuing stay, retrospective, and concurrent review.
• Default responses may be set for indicators.
• Criteria may be changed or discontinued at any time -data for discontinued criteria is retained.
• Online referral of findings to departments, committees, and physician peers.
• Can generate list of chart referred to a particular committee or department for further review.
• Permits inclusion of standardized severity, intensity, and other indicators required by PROs.
• Tracks follow-up reviews and generates report.
• Tracks denied days and avoidable days.
• Compiles and generates non-coverage letters.
• Tracks, categorizes, and reports non-coverage events and third party denials.
• Track multiple insurance types and authorizations.
• "Hotkey" access to financial counseling screen.
• Checks codes from third-party encoder and displays warning if codes do not match.

• Tracks demographic, licensure, educational and other information for each physician.
• Maintains confidentially of data via passwords and restricted menu access.
• Tracks expiration dates (physician licensure, board certification, DEA numbers, certifications).
• Message function allows user to record text comments or send a message to a physician.
• Tracks reappointment dates, privileges, committee membership, and committee attendance.
• Tracks malpractice insurance information, including expiration dates and coverage amounts.
• Tracks malpractice actions and case status.
• User can record queries and reports to the national practitioner databank.

• Allows infection surveillance reviews as outlined by the centers for disease control.
• Nursing can notify ICP of infection-related occurrence and automatically update ICP worklist.
• Records information related to infections (site, source, onset date, treatment, response, lab antibiotic).
• Generates/tracks reports and letters to governing agencies.
• Monitors/tracks inservice attendance; tracks policy and procedure reviews.

• Online occurrence reporting with user-defined tables and values and duplicate checking.
• Department managers may review occurrence reports and enter their investigation/follow-up.
• Risk manager may review/modify occurrence reports and investigation/follow-up information.
• Tracks actual or pending claims, claim status, activity, outcomes, settlements, actions and costs.

• All variables in database or related database may be searched and included in reports.