Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 1
Subtitle 07 - HOSPITALS
Chapter 10.07.01 - Acute General Hospitals and Special Hospitals
Section 10.07.01.18 - Record Maintenance by Utilization Review Agents
Universal Citation: MD Code Reg 10.07.01.18
Current through Register Vol. 51, No. 19, September 20, 2024
A. The plan shall describe how, in addition to maintaining documents which describe its utilization review procedures, the agent shall maintain the following records for each individual patient for whom any aspect of the utilization review procedure has been applied:
(1) The patient's name, hospital history
number, source of payment, and other demographic information capable of
identifying the patient.
(2) The
principal diagnosis or diagnoses (with corresponding codes listed in the
International Classification of Diseases, Ninth Revision, Clinical Modification
(ICD-9-CM) as defined in COMAR
10.09.06.01P),
and the particular category of patient chosen for review in accordance with the
hospital's utilization review plan.
(3) The date or dates on which review
activities were requested and the date or dates on which opinions were
rendered.
(4) The type of review
carried out, the nature of the criteria applied, and the results of the review.
In the case of disallowed services, the reasons for disallowance shall be
stated, as well as the name of the physician member of the agent's staff making
the final disallowance determination.
(5) In the case of objective second opinions,
documentation shall include the name of the physician rendering the second
opinion, the physician's specialty, and the nature of the opinion.
B. Each agent shall maintain a listing of all reviewed cases suitable for the selection of a sample of all cases reviewed within each 2-year certification period.
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