456.122—Evaluation criteria for admission review.
The UR plan must provide that—
(a)
The committee develops written medical care criteria to assess the need for admission; and
(b)
The committee develops more extensive written criteria for cases that its experience shows are—
(1)
Associated with high costs;
(2)
Associated with the frequent furnishing of excessive services; or
(3)
Attended by physicians whose patterns of care are frequently found to be questionable.