When performing Utilization Review, there will be many cases that are slam dunk Inpatient and a lot of cases that are clearly Outpatient. However, there will always be cases that are not so straightforward and require further research with supporting documentation to make the case for appropriate status. The cases whose distinction is yet to be determined are in the "Gray Zone."
This white paper gives an overview of the Gray Zone and gives actionable insight on how to handle cases that fall into it.
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