What we've learned building utilization management programs for hospitals nationwide — written for the people who run them.
Straightforward explanations of utilization management, denial prevention, and revenue cycle strategy — backed by real, verified hospital results.
What utilization management is, whether to outsource it, and how to pick a partner.
A plain-English guide to what UM actually does, why hospitals lose revenue without it, and how to evaluate an outsourced partner.
Read the Guide →Why hospitals bring in an outside UM team, what Medicare’s rules still require, and what to ask first.
Read the Guide →Seven questions to ask any hospital UM vendor, the red flags to watch for, and what good looks like.
Read the Guide →How concurrent review works, how clinical criteria are applied, and how inpatient status is decided.
Why continued-stay authorization has to be re-earned daily, not checked weekly — and what a real concurrent review program requires.
Read the Guide →Three reviews at three points in a stay — how they differ, and where denials slip through.
Read the Guide →How the two-midnight rule actually decides status, why the distinction is expensive to get wrong, and how to fix the process gaps behind it.
Read the Guide →Where the two best-known criteria sets fit in medical necessity review, and what changed for Medicare Advantage.
Read the Guide →Where revenue leaks and how hospitals prevent denials.
Root causes, the prevention workflow, and real denial-rate drops from five verified hospital engagements.
Read the Guide →Most revenue leakage opens up during the stay, not at billing. Where it starts and how real-time review closes it.
Read the Guide →What Medicare Advantage denials mean for hospitals, and what they cost.
When Medicare Advantage denies a patient's next placement, they stay in the hospital bed instead — new OIG data shows how often, and what that costs UM teams.
Read the Guide →Stuck bed-days and unappealed denials are two separate revenue leaks — new OIG data shows both, and what actually stops them.
Read the Guide →Plans can use internal coverage criteria only in specific cases, and must publish them — what that means for a continued-stay denial.
Read the Guide →Book a call and we'll show you exactly what's possible at your hospital — before any commitment.
Book a Free Call →