Improving UR Staff Level of Care Transition Management

BHCC measures and scores evidence of medical necessity. This helps UR staff to rapidly identify cases needing additional documentation or consideration of a level of care transition to decrease the chance of denial. If a patient’s evidence score appears too low to qualify for an extension of the current LOC, BHCC provides scores for alternative care options using the patient’s existing documents. This allows the facility to prevent the premature discharge of someone needing additional care. Doctors can make discharge or transfer decisions, and UR nurses can be prepared to discuss alternative care options during the UR call.

UR call preparation includes a quantified evidence of medical necessity for a patient’s status but anticipates a likely alternate LOC based on condition trends. This patient-centric feature ensures a patient receives the best level of care based on their clinical conditions and allows a facility to optimize their LOS based on their LOC range coverage.

BHCC pre-scores evidence strength, including step-up or step-down alternatives. Improved LOC management increases patient LOS as clinically indicated and provides a seamless LOC transition. This ensures patients receive the best care based on their clinical needs.

By anticipating reviews with advanced medical necessity strength compensating for potential level-of-care transitions, BHCC increases successful reviews, providing more patients with the LOS to which they are clinically entitled.

BHCC patient-centric UR approach strengthens behavioral healthcare facilities:

• Pre-scores evidence of medical necessity for potential level-of-care transitions.
• Prepares UR nurses to extend the length of stay through an alternative LOC in the event of a denial.
• Mitigates risk of premature patient discharge.

Through improved LOC step-up/step-down management, patients receive the length of stay clinically indicated with a seamless transition.