Understanding the hidden impact of utilization review on hospitals

Wednesday, July 29th, 2020 | 11:00 am - 12:00 pm CT

Utilization review (UR) has a profound and hidden impact on financial and compliance issues and goals that is often misunderstood. For example, if an inpatient case is sent to a physician advisor for additional medical necessity review and is recommended as inpatient by the physician advisor, many financial leaders think this process was a waste of time and money—but is it really?

This session seeks to more clearly articulate some of the revenue integrity and compliance impacts of typical utilization review processes. Join us as we debunk prevalent UR myths and equip financial and operational leaders to better understand the true value of utilization review, helping you make a clearer case for appropriate resources and funding. We’ll provide an analytical framework for weighing the costs and benefits of issues such as length of stay and managing the intricacies of patient admission strategy. This session will introduce you to the four key pillars of an effective utilization review program.

Learning objectives:

  • Discover the invisible consequences of typical UR processes
  • Set a clear vision of the true value of a solid utilization review program
  • Understand how to invest and align your UR group to make them more effective
  • Apply the four key pillars of an effective utilization review program to your organization



Kurt Hopfensperger_2.5MB - Cierra Levy

Kurt Hopfensperger, MD, JD

Regional Vice President, Provider Relations and Education, Optum360

Tabitha Hapeman Headshot Feb 2020 USE THIS - Cierra Levy

Tabitha Hapeman, RN, BSN, RN-BC

Manager, Resource Management Cente, Manager, Patient Financial Services, Revenue Management Department, Sentara Healthcare