Concurrent Review
Concurrent review nurses and medical directors review and
evaluate hospital admissions concurrently using nationally recognized criteria.
Initial reviews are conducted within 24 hours or the next business day of admission.
Subsequent reviews are conducted regularly at intervals which are dependent on the
specific clinical condition being treated.
At each initial and subsequent review, the recipient's clinical information is evaluated to determine:
- Appropriateness of the level of care
- Estimated length of stay based on optimal recovery guidelines for the diagnosis
- Planning needs for transfers to other facilities such as rehabilitation or skilled nursing facilities
- Discharge planning needs
Concurrent
reviews entail regular communication between facilities and concurrent review staff;
daily delivery of the hospital's Medicaid census to SAMAI is expected either by
fax or other means. Concurrent review staff focus subsequent concurrent reviews
efforts only on those cases likely to benefit from timely information exchanges.
This is done by telephone and fax. Only those elements of clinical information necessary
to ensure timely transition of care and discharge planning are gathered.