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Utilization Review Standards 2022

NDHA is an approved provider of continuing education by the North Dakota Board of Examiners for Nursing Home Administrators.

Date: 7/19/22

9:00 AM – 10:30 AM Central time


Registration fees:       $175 per NDHA member  |  $225 per non-member


Chief Medical Officer, Chief Nursing Officer, Compliance Officer, Emergency Department Personnel, Joint Commission Coordinator, Medical Records, Quality Improvement personnel, Risk Manager, and Legal Counsel.


This program will cover the Centers for Medicare & Medicaid Services (CMS) hospital Conditions of Participation regulations for Utilization Review (UR). Each hospital that accepts Medicare and Medicaid reimbursement must comply with these standards. Facilities must comply with the UR standards to avoid penalties from the Recovery Audit Contractors (RACs) and other organizations such as the Office of Inspector General (OIG). This webinar will discuss what is typically found in a UR plan and why hospitals get cited by CMS. Information will also be provided about deficiency reports.


At the conclusion of this session, participants should be able to:

  • Recall that the hospital must have a UR plan.
  • Discuss the importance of documentation of medical necessity by the physician in the medical record.
  • Explain that hospitals are required to have a UR committee.
  • Describe the basics and rationale of the Medicare Outpatient Observation Notice (MOON).



Susan Seeley has over 40 years of experience in the health care industry, both as a nurse leader and as a clinical consultant with a focus on patient care services and regulatory compliance. She is experienced in conducting mock surveys and improving client hospitals’ accreditation survey preparedness through on-site education. Susan has helped organizations achieve continuous survey readiness and assists organizations with writing and implementing successful Plans of Corrections for survey deficiencies. She has also assessed quality programs, clinical operations, the structure and function of medical staff committees, and the implementation of peer review quality plans. Prior to becoming a consultant, Susan spent 19 years as the chief nursing officer for a rural Florida hospital while working part time for the parent company as a clinical consultant for their more than 200 hospitals. She earned her Master of Science in Nursing Administration and her Bachelor of Science in Nursing from Barry University in Miami Shores, Florida. She is a registered nurse and holds an Advanced Nurse Administrator certification through the American Nurses Association.


This speaker has no real or perceived conflicts of interest that relate to this presentation.



Jul 19 2022


9:00 am - 10:30 am

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