How would you handle Utilization Review asking you to discharge a patient who doesn’t want to go home yet?
Protecting the hospital's bottom line from insurance denials is the basis for UR actions, and thus is based on compliance with established insurance company formulae. Therefore, any non-compliance on your part will pit you against the hospital. However, it is usually easy to find a solution that benefits everyone.
"If it were dangerous to send a patient home, I would dictate a note of necessity for keeping the patient, based on medical grounds.
This way the UR Department can send it for approval by the third-party payer. On the other hand, if a patient just wanted to stay for some non-medical reason, I would explain that having satisfied criteria for discharge requires discharge, but that I would be happy to offer home health follow-up if his or her plan allows for it."