Administrative Memos

200605

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jul 05, 2006
SUBJECT: Medicaid Review Determination Profiles April 1, 2005 - March 31, 2006 January 1, 2006 - March 31, 2006
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, 2005 - March 31, 2006 and consists of: (a) the 1-page summary of review findings of your hospital for the 12-month period, and (b) the 1-page summary of review findings for all the hospitals in your peer group (for comparison purposes).

The other set summarizes review findings for the period January 1 - March 31, 2006 and consists of: (a) the 1-page summary of review findings of your hospital for the 3-month period, (b) the 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, and only includes information for the first three review categories from the summary report (i.e., Retrospective, DRG and Enhanced UR Program)), and (c) the 1-page summary of review findings for all the hospitals in your peer group (for comparison purposes).

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(s). 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.