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

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. [...]

Debating the Pros and Cons of Medicare for All

More than 27 million Americans currently do not have health insurance of any kind, and even more are underinsured. But those who do have adequate health insurance are hardly out of the woods. Many current health plans feature massive deductibles. In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the K [...]

Is LOS relevant any more

The Myth of Length of Stay, Revisited

Focus on length of stay has been ongoing since 1983. Yet we all know that If cost per case is less than the DRG reimbursement, the per diem rate, the bundled payment, or the value-based benchmark, the hospital achieves a margin no matter what the LOS might be. If quality patient outcomes and financial viability are the hospital's goals, then it's time to switch strategies. [...]

COVID-19 Patient Treated at Home

On April 30, 2020, CMS published an interim final rule (IFR) that made regulatory changes and clarified certain policies in response to the Coronavirus (COVID-19) public health emergency (PHE). The IFR’s changes include increased flexibilities for hospitals to provide and receive Medicare payment for hospital outpatient services to patients in their homes. IN DEPTH [...]

Glenn Krauss, CDI

Seeking A New Purpose for CDI in 2020

We're delighted to feature Glenn Krauss, noted subject matter expert on the practice of clinical documentation and a fearless fighter to help CDI specialists transform their task oriented focus to meet the demands of clear and concise medical documentation in today's marketplace. [...]