Administrative Memos

200503

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jun 30, 2005
SUBJECT: MEDICAID REVIEW DETERMINATION PROFILES APRIL 1, 2004 - MARCH 31, 2005, JANUARY 1, 2005 - MARCH 31, 2005
IPRO CONTACTS:

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

Enclosed are two (2) sets of reports summarizing the Medicaid Utilization, DRG, and Quality reviews conducted by IPRO under the Medicaid Case Payment System.

One set summarizes review findings for the period April 1, 2004 - March 31, 2005 and consists of the following two reports:

• A 1-page summary of review findings of your hospital for the 12-month period, and
• A 1-page summary of review findings for all the hospitals in your peer group (for comparison purposes). The second set of reports summarizes review findings for the period January 1 - March 31, 2005 and consists of the following two reports:
• A 1-page summary of review findings of your hospital for the 3-month period, 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).

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.