55 Pa. Code § 1163.479. Medical Care Evaluation studies.

§ 1163.479. Medical Care Evaluation studies.

(a)  The hospital utilization review committee shall conduct Medical Care Evaluation (MCE) studies in accordance with this section.
(b)  MCE studies shall identify and analyze medical or administrative factors related to patient care rendered in the hospital and, when indicated, make recommendations for changes that would be beneficial to patients, staff, the hospital and the community.
(c)  MCE studies shall include analysis of at least:
   (1)  Admissions.
   (2)  Length of stay.
   (3)  Diagnostic categories.
   (4)  Ancillary services, including drugs and biologicals.
   (5)  Professional services performed in the hospital.
(d)  At least one MCE study shall be in progress at any time.
(e)  At least one MCE study shall be completed each calendar year.
(f)  The results of each MCE study shall be documented.
(g)  Documentation shall be made describing how the MCE study results have been used to institute improvements in the quality of care and to promote the efficient and effective use of hospital facilities.

Source

   The provisions of this §  1163.479 adopted June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185.

Cross References

   This section cited in 55 Pa. Code §  1163.457 (relating to payment policies relating to out-of-State hospitals); 55 Pa. Code §  1163.458 (relating to payment policies relating to same-calendar-day admissions and discharges); 55 Pa. Code §  1163.473 (relating to hospital utilization review plan); and 55 Pa. Code §  1163.475 (relating to responsibilities of the hospital utilization review committee).

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