Common use of Inpatient Medical Necessity and Appropriateness Review Clause in Contracts

Inpatient Medical Necessity and Appropriateness Review. The IRO shall: (1) evaluate and analyze Dignity Health’s inpatient admissions and relevant length of stays to determine if such admissions and length of stays (as identified in Section A. 2.b of Appendix C) were medically necessary and appropriate under the applicable Federal health care program rules and regulations governing inpatient admission, treatment, discharge, billing, and reimbursement, and (2) determine whether the claims submissions to Federal health care programs associated with each inpatient admission were documented, coded, and billed appropriately (Inpatient Medical Necessity and Appropriateness Review). The IRO shall prepare an Inpatient Medical Necessity and Appropriateness Review Report, as outlined in Appendix C to this CIA, which is incorporated by reference.

Inpatient Medical Necessity and Appropriateness Review. The IRO shall: (1) evaluate and analyze Dignity HealthMCCG’s inpatient admissions and relevant length of stays to determine if such admissions and length of stays (as identified in Section A. 2.b Section A.1.b of Appendix C) were medically necessary and appropriate under the applicable Federal health care program rules and regulations governing inpatient admission, treatment, discharge, billing, and reimbursement, and (2) determine whether the claims submissions to Federal health care programs associated with each inpatient admission were documented, coded, and billed appropriately (Inpatient Medical Necessity and Appropriateness Review). The IRO shall prepare an Inpatient Medical Necessity and Appropriateness Review Report, as outlined in Appendix C to this CIA, which is incorporated by reference.

Inpatient Medical Necessity and Appropriateness Review. The IRO shall: (1) evaluate and analyze Dignity HealthBanner’s inpatient admissions and relevant length of stays at the Covered Facilities to determine if such admissions and length of stays (as identified in Section A. 2.b Section A.1.b of Appendix C) were medically necessary and appropriate under the applicable Federal health care program Medicare rules and regulations governing inpatient admission, treatment, discharge, billing, and reimbursement, and (2) determine whether the claims submissions to Federal health care programs Medicare associated with each inpatient admission were documented, coded, and billed appropriately (Inpatient Medical Necessity and Appropriateness Review). The IRO shall prepare an Inpatient Medical Necessity and Appropriateness Review Report, as outlined in Appendix C to this CIA, which is incorporated by reference.reference.‌