QUESTION 15 OF 20
How would you handle a problem in which Utilization Review wants you to discharge a patient who you feel isn’t medically ready for discharge?
This pits you against the hospital, but you want to propose a solution that is safe, while considering insurance complications. UR actions are usually based on dollar issues, protecting the hospital bottom line from insurance denials.
"If I felt it would be dangerous to send a patient home, I would write a note of necessity for continued admission, on medical grounds, so that UR could submit it for approval from a third-party payer. If the patient just wanted to stay for his or her convenience, I would explain that he or she has satisfied criteria for discharge, but I would also offer home health follow-up, if the patient desired and it were allowed."
