Utilization Management In The Clinical Laboratory And Other Ancillary Services

This book is the first comprehensive text on utilization management in the clinical laboratory and other ancillary services. It provides a detailed overview on how to establish a successful utilization management program, focusing on such issues as leadership, governance, informatics, and application of utilization management tools. The volume also describes ways to establish utilization management programs for multiple specialties, including anatomic pathology and cytology, hematology, radiology, clinical chemistry, and genetic testing among other specialties. Numerous examples of specific utilization management initiatives are also described that can be imported to other heath care organizations. A chapter on utilization management in Canada is also included. Edited by an established national leader in utilization management, Utilization Management in the Clinical Laboratory and Other Ancillary Services is a valuable resource for physicians, pathologists, laboratory directors, hospital administrators, and medical insurance professionals looking to implement a utilization management program.

Self-assessment Q&A in Clinical Laboratory Science, III, adds a variety of subject matter that addresses new concepts and emerging technology, particularly in the areas of kidney biomarkers, cancer biomarkers, molecular diagnostics, multiple myeloma, pharmacogenomics, novel cardiovascular biomarkers and biomarkers of neurologic diseases. The field of Clinical Laboratory Science continues to evolve and editor Alan Wu has once again brought together experts in the field to cover the contemporary topics that are being tested today. This updated bank of questions and answers is a must-have to sharpen knowledge and skills. Contains nearly 800 multiple choice questions with correct answer explanations Assists readers in determining knowledge gaps so they can better study for certification examinations and remain current in this rapidly changing field Provides a format that is conducive to quick learning in digestible segments Includes beneficial citations for additional study

This issue of Clinics in Laboratory Medicine, Guest Edited by Dr. Anand S. Dighe, will focus on Clinical Decision Support, including tools, strategies, and emerging technologies. This issue is one of four issues selected per year by the series Consulting Editor, Milenko Jovan Tanasijevic. Topics include, but are not limited to, The Laboratory’s Role in Clinical Decision Support, Integrating Decision Support into a Utilization Management Program, Decision Support Tools within the Electronic Health Record, Decision Support to Enhance Automated Testing and Laboratory Workflow, Laboratory-based CDS programs, Decision Support in Blood Banking, Decision Support in Molecular Pathology, A Computational Perspective on Decision Support, Emerging Decision Support Techniques, Decision Support and Patient Safety, Decision Support from a Reference laboratory perspective, and Training Aspects of Laboratory Based Decision Support.

A basic guide to hospital billing and reimbursement, Understanding Hospital Billing and Coding, 3rd Edition helps you understand, complete, and submit the UB-04 claim form that is used for all Medicare and privately insured patients. It describes how hospitals are reimbursed for patient care and services, showing how the UB-04 claim form reflects the flow of patient data from the time of admission to the time of discharge. Written by coding expert Debra P. Ferenc, this book also ensures that you understand the essentials of ICD-10-CM and develop skills in both inpatient coding and outpatient/ambulatory surgery coding. UB-04 Claim Simulation on the companion Evolve website lets you practice entering information from source documents into the claim form. Over 300 illustrations and graphics bring important concepts to life. Detailed chapter objectives highlight what you are expected to learn. Key terms, acronyms, and abbreviations with definitions are included in each chapter. Concept Review boxes reinforce key concepts. Test Your Knowledge exercises reinforce lessons as you progress through the material. Chapter summaries review key concepts. Practice hospital cases let you apply concepts to real-life scenarios. Updated Claim Forms chapter covers the UB-04 claim form. Updated information covers diagnosis and procedural coding, with guidelines and applications. Updated claim forms and names are used throughout.

Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate. This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.

Rightsizing is the process of determining whether a medical practice has the right number of staff doing the right things at the right time, with the right resources to achieve optimal practice performance. With declining reimbursement and increasing costs, medical practice executives frequently look to staffing as a means of reducing costs. Before taking action, however, they need to know that a higher level of staffing may increase practice revenue. Authors Deborah Walker and David Gans provide the systematic approach to rightsizing staff in the medical practice. They outline a five-step process to benchmark and analyze current staffing, productivity and work processes to realign staffing levels and responsibilities. This book includes a number of tools and resources to help practice executives apply the staff rightsizing process to their organizations. By following the authors' guidelines, practice leaders will realize that rightsizing doesn't always mean downsizing or reducing costs. It means having the right number and right mix of staff to ensure optimal physician productivity and practice efficiency to maximize the practice's financial performance. Book jacket.