The largest online database anywhere of free accreditation advice for frontline and management employees in healthcare.
For well over a decade, we've been gathering what we know about accreditation standards and putting that knowledge into plain language. The product of those years of study and writing is this database of accreditation tips. Whenever we learn something new about a standard or the way the reviewers are interpreting it, we update our database.
Search the articles below. Get more accurate results by entering in the standard name or accreditation program.
This standard sets for the minimum requirements for your appeals records:Patient nameName of provider and/or facility rendering serviceCopies of all patient correspondenceCopies of all provider/facility correspondenceActions taken and the dates they were taken, including decisions, correspondence, and resolutionMinutes from any appeal proceedingsThe name and credentials of the appeals reviewer for...READ FULL POST
This standard prescribes the minimum requirements for the written notice of an adverse appeal decision (one upholding the initial denial of the request for certification):It must be sent to the patient and ordering provider or facilityIt must state the principal reasons for the decisionIt must state that your organization will provide the clinical rationale underlying decision in response to a wri...READ FULL POST
This standard requires that, in the case of a standard appeal, you send written notification of the decision within 30 calendar days of the receipt of the request for appeal. That notice needs to go to both the patient and the ordering provider or treating facility.READ FULL POST
The standard's purpose is to establish time frames for notification of the patient and provider in the event of expedited appeals. There are two of them:72 hours from the request to a verbal notification of the appeals decision3 calendar days from the verbal notification to a written notification of the appeals decisionThe 72-hour verbal notice need go only to the requesting party, whether it be t...READ FULL POST
This standard requires that each appeal reviewer, for each case, attests in some manner that he/she:is licensed or certified in a field that typically manages the clinical issue under review andhas current and relevant knowledge and/or experience to render a determination for the case he/she is reviewing on appeal.It's important to remember that this is for each case, and must be documented.READ FULL POST
Drug utilization management (DrUM) appeals may be considered either by the clinical peers that can handle utilization management appeals or pharmacists who:Hold an unrestricted, active license or certification to practice pharmacy in the U.S.;Is on U.S. soil when conducting the appeal review (unless explicitly allowed by state or federal law);Did not make the original non-certification decision;Is...READ FULL POST
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