Administrative Memos

200501

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 05, 2005
SUBJECT: MEDICAID REVIEW DETERMINATION PROFILES JULY 1, 2004 - SEPTEMBER 30, 2004
IPRO CONTACTS:

Michael Lebert, Director, Data Analysis & Evaluation, Ext. 630

Enclosed is the quarterly Medicaid Review Determination Profile report summarizing the Medicaid Utilization, DRG, and Quality reviews conducted by IPRO under the Medicaid Case Payment System. The report summarizes review findings for the period July 1, 2004 - September 30, 2004 and consists of the following:

• A 1-page summary of review findings of your hospital for the 3-month period,
• A 1-page summary of review findings for all the hospitals in your peer group (for comparison purposes), and
• A case listing report of UR/DRG/Quality review determination results for your hospital for the 3-month period. The case listing includes case-specific information on all reviews completed during the reporting period, including final and appeal review determinations (for Admission, LOS, DRG and Quality) and cases technically denied. The case listing only includes information for the first three review categories from the summary report (i.e., Retrospective, DRG and Enhanced UR Program).

You will also find enclosed a glossary of terms for the Medicaid Review Determination Profiles.

Please note this report only identifies review activity that occurred during the aforementioned reporting period. For those cases with subsequent appeal determinations occurring after the aforementioned reporting period, those outcome decisions will be reflected in a future report (based on the date that the determination was made).

Should you have any questions or comments about these reports or the reporting of review findings, please feel free to contact Michael Lebert, Director, Data Analysis & Evaluation, at (516) 326-7767, extension 630.