Guidelines for the Review Coordinator in PSRO Programs and/or Utilization Review Activities - Technical Assistance Document No.2 - Purpose and Role

Sep 21, 2026

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Guidelines for PSRO programs and/or Utilization Review activities define how review coordinators should be selected, what responsibilities they may hold, and which organizational mechanisms support effective fulfillment of those responsibilities. The document explains the role of supportive personnel in conserving physician review time, describes typical backgrounds that may qualify as review coordinators, and clarifies limits of decision-making requiring physician judgment. It details core functions such as on-site admission certifications, continued-stay review, discharge planning support, data collection, notifications, and reporting.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

B. Purpose of this document

C. The review coordinator's role

1. Conducting on-site admission certifications and continued stay review

2. Working with institutional personnel to initiate discharge planning

3. Collecting information and data for retrospective review

4. Notifying relevant agencies, physicians, and the patient when applicable

5. Completing reports on review activities

6. Maintaining liaison with social, health and community agencies

TA2 GUIDELINES FOR THE REVIEW COORDINATORIN PSRO PROGRAMSAND/OR UTILIZATION REVIEW ACTIVITIES November 7,1975 U.S.DEPARTMENT OF HEALTH,EDUCATION,AND WELFARE PUBLIC HEALTH SERVICEHEALTH SERVICES ADMINISTRATION B SSURANCE 9 MEMORANDUM A3 T4-2 (975 TO PSRO Planning,Conditional,andSupport Center Organizations;DHEW PHS Regional PSRO Consultants FROM :Director SUBJECT:Guidelines for the Review Coordinator in PSRO Programs and/orUtilization Review Activities Introduction A. DATE: NOV7 1975 TECHNICAL ASSISTANCEDOCUMENT NO.2 Supportive personnel may be employed by the PSRO or theinstitution(hospital or long-term care facility)delegatedPSRO review or performing Utilization Review for the purposeof conserving physician review time.Such personnel mayperform screening functions and data collection,usingphysician established norms,criteria and standards,as wellas other related supportive functions to assist in assuringeffective and timely review.Matters requiring medicaljudgment must be referred to a physician or to a committeeof physicians. Review coordinators represent one category of supportivepersonnel that has evolved with the development of utiliza-tion and medical care review systems.These individualsmay function directly under the PSRO,in a hospital delegatedPSRO review,or in an institution performing review under theUtilization Review Regulations.The guidelines presentedin this technical assistance document may be applied in al1of these situations. No single model for the types and numbers of personnel tobe identified as review coordinator(s)can be proposed thatwil1 meet the needs of every PSRO or institution delegatedreview.Such determination wil1 have to be based upon localcircumstances.However,considerations should include,ata minimum,the available manpower resources,the anticipated volume of reviews to be performed,the scope of responsibilityto be assigned to the review coordinator in each setting aswel1 as the proposed working relationships with the physiciansparticipating in the review system.Whatever the plan foremploying the category,"review coordinator(s),"in itspersonnel system,the local group should be able to describethe rationale for that structure in terms of maximizingefficiency in relation to the budgetary provisions for thereview program. In light of the above variables it is possible to assign thetitle,"review coordinator,"to individuals with differenttypes of background,training,and experience.These include: (1)medical records technicians,(2)clerical personnel including ward clerks,(3)medical technicians,(4)registerednurses,(5)licensed practical nurses,(6)former militarymedical corpsmen,or(7)other clinical personnel whoseprimary responsibility is related to patient care who performaspects of required review in an institution.Review coordina-tors may be employed for the performance of review activitieson a ful1-or part-time basis. Obviously,the scope of responsibility assigned to the reviewcoordinator wil1 be based upon both the level of decision-makingaccorded in official guidelines,ie.,only physicians may makedenial decisions,and the background qualifications of the indi-vidual to be placed in the position.While explicit criteriamust be utilized in the review of each admission,certain diagnosesare,in themselves,the justifying criteria. In these lattersituations,the individual performing the review coordinatorfunction may be someone who has had experience as a clerk in ahospital admitting office.Alternatively,it may be desirableto have a registered nurse fil1 the position if the rcsponsibilitiesinclude the full spectrum of implementation,coordination,documentation and management of the day-to-day activities thatwill be necessary to accomplish the review requirements of thePSRO or the Utilization Review Regulations. # B.Purpose of this document These guidelines are presented to assist those PSROs and/orinstitutions planning to utilize the services of the

FAQs

What is the purpose of the review coordinator guidelines in PSRO and Utilization Review programs?

They support PSROs and institutions in planning to use review coordinators by defining qualifications, appropriate responsibilities, and organizational mechanisms that foster effective fulfillment of those responsibilities.

What responsibilities may review coordinators take in admission and continued-stay review?

They may screen admissions against physician criteria, assign initial lengths of stay using local norms, refer cases not meeting criteria to a higher level reviewer, assign justified extensions, and collect and record required medical and other data.

When must medical judgment be referred to a physician?

Matters requiring medical judgment must be referred to a physician or a committee of physicians, and denial decisions are restricted to physicians under the guidelines.

Sep 21, 2026

Upload by Riley