The Basics

This short standard is designed primarily to protect hospitals from burdensome unnecessarily frequent reviews to determine whether a patient's stay should be extended.  It accomplishes this aim by requiring that the UM organization determine the frequency of its reviews based on the severity of the patient's illness, not on some arbitrary frequency (such as daily).  So, while it might be administratively easier for the UM organization simply to make a determination every day about all of its patients, it cannot do so.  

Management Tips

The applicable P&P should state this quite clearly -- the frequency of reviews for in-patient treatment should be based on the patient's condition.  It will be incumbent on you to make sure your staff is clear on this point.  About the only way you'll miss this standard is if a concurrent review nurse, in her interview with the URAC reviewer, says something like "I do a review every day of all our hospital patients."

URAC Accreditation Tips

This standard has a weight of 4.

The P&P on frequency of reviews is all you'll need to submit for the desktop review.  As mentioned, above, however, the key to demonstrating compliance with this standard will be in the interview -- often telephonic -- of your concurrent review nurse.  He/she will need to be very clear on your policy, as it's almost certain that the reviewer will ask a question on this standard.