Case Management Advisor

Most Recent Updates
by Phoenix Medical Management, Inc.

The rapidly evolving marketplace requires new competencies to effectively manage high-risk and at-risk patients as they navigate the acute and post-acute episodes of care. The models of the 1990s must be transformed to accomodate the expectations of new ACOs, risk based contracts, bundled services, patient centered care, and new delivery of care settings.  

We welcome your thoughts or your critique. Feel free to send an email to

IPPS, maternal health, mother's day, CMS, obstetrics, births, complications, expectant mothers

IPPS and Maternal Health

The U.S. has the highest rate of maternal deaths among high-income countries. IPPS has set new standards in the 2023 IPPS ruling that could impact maternal care designations. [...]

palliative care, transition of care, hospice, utilization, quality of life

Palliative Care a Win for Both Patient and Hospital System

Palliative care does not always equal Hospice, and can provide success for both the patient and the hospital system. So, the topic to consider is, how do we involve palliative care and how can it improve the patients’ transition of care? [...]

home health disparities, comparing urban and rural communities

Evaluating outcomes of home health: a comparison of rural and urban settings

The Journal of Rural Health published a recent article by the New York University (NYU) college of nursing that is catching some buzz regarding the health disparities between urban and rural settings. The study looked at process and outcome measures over a five-year period, from 2014 to 2018. They compared the two geographic regions across approximately 7,900 home health agencies, looking at the [...]

case management, staffing shortages, recruitment, retaining staff

The Great Exodus is Hitting Case Management

Nurses, social workers, therapists, advanced practice providers, etc. are leaving in droves for a better opportunity that offers flexibility, ability to work from home, better benefits, and higher pay. However, for the staff that are unable to leave their current employer because of personal circumstances, disengagement is at new levels with burnout associated with the ongoing pandemic and subsequ [...]

short stay audits

Short Stay Auditors are on their way: Are you prepared?

Review Dr. Zelem's latest article on RACMonitor, regarding Livanta's award of short-stay audits and how occurrence span code 72 may ensure you are prepared with appropriate documentation and coding. [...]

Condition Code 44

Condition Code 44: How many should you have?

Check out our latest article on RACMonitor regarding Condition Code 44s at Also make sure to check out Dr. Juliet Ugarte Hopkins article “Deconstructing the Concept of Condition Code 44,” which includes a complete history and best model approach to the Condition Code 44 process. [...]

utilization review, continued stay

The Breakdown on continued stay reviews

Check out our recent posting on RacMonitor,, to obtain a better understanding of continued stay reviews. What are they really for? [...]

case management, hospitalist

Building a Partnership with your Hospitalist

Case management can be explained as the hub of the wheel that connects all disciplines to the patient with its primary spoke being the physician. The case management team, including the utilization review specialist can inform and educate the hospitalist on access, progress of care and transition opportunities that optimize resource utilization. Several avenues can assist in educating the hospital [...]

non-emergency ED visits

Addressing UHCs stance on non-emergent ED visits

Right time, right place, right setting…. well maybe. In UHC’s network bulletin ….that was quickly retracted and held for delay after the AHA and AMA expressed extreme ethical concerns. [...]

JHU report on predatory practices for Axios

Patient billing may have gone too far!

Catch the official report on RACMonitor’s Monitor Monday podcast! Last week Johns Hopkins University released an interesting report to Axios that highlighted the top 100 US hospitals that have accrued revenue by suing patients over unpaid medical bills between January 2018 to July 2020. [...]

PCMH, primary care first

Primary Care First makes it easier to integrate care management

A comprehensive care management program can be costly and often not justified with past payment models. However, the PCF model provides a solution for this by offering up-front, partially capitated payments to allow for funding this foundational program. [...]

Medicare Compliance Report

Medicare Forms: Second IMM & the HINNs

Check out Phoenix Medical Management's latest contribution to the Report on Medicare Compliance regarding all things associated with the Medicare forms. [...]

Hospital at home

Understanding Hospital at Home

Review the new provisions and how to participate in the Hospital at Home program. This article published for RACmonitor, describes how this program can help in a FFS and value based world. [...]

connections in clinical documentation integrity, CDI

Connection in Revenue Cycle Improvement

Phoenix Medical Management was able to participate with a small group of experts to discuss how to evaluate and improve the CDI world. Jim shares his white-paper on how an outsiders prospective for process improvement can be applied to clinical documentation integrity. [...]

Leading a multi-care management system during covid

Leading Case Management during lock down

The isolation and experience of COVID is something that will unite us all as something we will never forget. Marie shares her accounts while hospitals were on lock down, what leading a case management program was like. [...]

CMS, Surveys

CMS to Resume Surveys

This is a good time to ensure you are ready for CMS to walk through the hospital doors. [...]

discharge planning, home health services,

Fraud and abuse in the form of free discharge planning

Many case management departments will allow post acute providers to support the discharge process in order to gain referrals. However, this comes at a big risk. CMS requires that patients are provided choice and quality data regarding options for home health, post acute, and hospice. Hospital case management departments will want to ensure that they are compliant when they allow vendors through [...]

severity coding

OIG Report: Data brief with concerns for potential upcoding

The OIG found a 20% increase in the number of stays for the highest severity level, nearly accounting for half of all Medicare inpatient spending. At the same time, the average length of stay decreased for these high severity stays. [...]

gatekeeper, front-end- revenue cycle, case management, access management, utilization review

Gatekeepers of the ED

Examining your front end revenue cycle process by positioning CM and UR in the emergency department. Article published on RacMonitor, [...]

leadership, hospital unit based

How can unit-based leadership improve performance metrics?

On January 12, 2021, Taylor & Francis, published in the Journal of Hospital Practice, the Impact of a hospital unit-based leadership triad on key performance metrics. They discovered that having physician, nursing, and case management leadership empowered and aligned in the same metrics for performance they were able to achieve improvements in length of stay and progression of care metrics. [...]