The financial benefits of an effective hospitalwide quality assurance/utilization management program.

Research output: Contribution to journalArticle

Abstract

This article describes the organizational structure and functions of the quality assurance/utilization management (QA/UM) department at The Johns Hopkins Hospital (Baltimore), which has developed a proactive QA/UM program for identifying opportunities to control inappropriate inpatient admissions, shorten a patient's length of stay, monitor the use of ancillary services, and improve physician documentation in patient medical records. In addition, the QA/UM department has developed and implemented an aggressive third-party appeal mechanism to ensure that the institution has an effective UM program. The QA/UM department annually recovers more than 3 million dollars for the hospital by aggressively appealing third-party payer denials. Specific chart-review variables are outlined.

Original languageEnglish (US)
Pages (from-to)259-265
Number of pages7
JournalQRB. Quality review bulletin
Volume18
Issue number8
DOIs
StatePublished - Aug 1992

ASJC Scopus subject areas

  • Leadership and Management

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