a. Provide secondary utilization review process services for all patients that require inpatient stay but do not meet criteria using the state-approved InterQual or MCG software. This shall include receiving referral and providing timely response to secondary reviews, appeals, progress and performance reporting within a context of open and available communication with ARMC physicians to discuss level of care of hospitalized patients. b. Provide qualified personnel to perform and complete the services. c. A physician reviewer must be available to provide services onsite at ARMC when requested by ARMC. d. A supervising member of proposer’s physician staff must be available for timely direct phone conversation with hospital’s physicians to discuss level of care of hospitalized patients when there is disagreement between proposer’s physician advisor and the hospital physician. e. Provide medical necessity reviews for each day the patient does not meet an acute level of care using InterQual or MCG software for TAR free cases. f. Provide medical necessity reviews, either concurrently or retrospectively, for Medicare patients admitted for one day. g. Reviewer must sign off on the approved days in writing with a clinical reason for justifying the inpatient stay. h. Provide response within 60 minutes or less on Emergency Department cases and within two hours of all other cases. i. Provide ongoing education regarding appropriate status and recommendations for clinical documentation. j. Real Time reporting regarding number of cases referred, percentage of inpatient vs observation cases, number of secondary reviews, and time to completion for each review.
