Utilization Management Workshop Series: Best Practice Applications for the Hospital Setting Part 1-Utilization Management Series Part 1 Recording

Video Transcription

Video Summary

The video features Bev Cunningham and Dr. Tony Sesta discussing the significance of utilization management in healthcare, especially in assessing medical necessity for patient care levels. They stress proactive collaboration between case managers and physicians, utilizing medical criteria, and involving physician advisors when needed. The speakers delve into medical necessity assessments in psychiatric hospitals, highlighting the importance of clinical judgment and following DSM criteria. They also discuss escalating cases to physician advisors for reviews and documenting these interactions for payers. The video emphasizes the vital role of utilization management in ensuring quality care and resource utilization, underscoring collaborative efforts among healthcare team members for medical necessity decisions and efficient care delivery. It also addresses revenue cycle impact, regulatory issues, and the documentation required in utilization management processes, focusing on optimizing patient care, revenue outcomes, and compliance with regulations.

Keywords

Bev Cunningham

Dr. Tony Sesta

utilization management

healthcare

medical necessity

patient care levels

case managers

physicians

medical criteria

physician advisors

psychiatric hospitals

clinical judgment

DSM criteria

physician reviews

payer documentation