Hospital Utilization Management: A Casebook on Medicare Two-Midnight Rule, Denials, Appeals, and Documentation for Physician Advisors and Case Manager

Name: Hospital Utilization Management: A Casebook on Medicare Two-Midnight Rule, Denials, Appeals, and Documentation for Physician Advisors and Case Manager
Brand: Independently Published
SKU: 9798195384012
Price: 3378.0 INR
Availability: InStock

by Fa Marcus T. Whitfield

Save 14%

₹3,378.00

₹3,926.00

(-14%)

₹3,378.00

Imported Edition - Ships in 18-21 Days

Free Shipping in India on orders above Rs. 500

Request Bulk Quantity Quote

Name

Quantity

+91

Company Name

Message

Quantity

More Information

ISBN13: 9798195384012
Binding: Paperback
Subject: N/A
Publisher: Independently Published
Publisher Imprint: Independently Published
Publication Date: May 3, 2026
Pages: 108
Original Price: GBP 30.2
Language: English
Edition: N/A
Item Weight: 268 grams
BISAC Subject(s): Hospital Administration & Care

About The Book

The hospital utilization management environment of 2026 is the most complex it has ever been. The Two-Midnight Rule now governs Medicare Advantage. The Inpatient-Only list is being phased out. New payer policies - Aetna's Level of Severity, Blue Cross NC's status reforms, UnitedHealthcare's Optum routing - are reshaping how denials reach the hospital and how appeals must be pursued. Patient notice forms transitioned in waves through the spring of 2026. Artificial intelligence now sits at the center of payer prior authorization, and the litigation around it is just beginning.

Hospital Utilization Management: A Casebook is the practical, regulation-current guide physician advisors and case managers have been waiting for. Written by a practicing physician advisor, this book combines clear regulatory analysis with sixteen real-world case scenarios drawn from daily UM practice - each walking through the patient vignette, the status question, the case manager's review, the physician advisor's analysis, the decision and documentation, the common pitfalls, and the specific regulatory citations that govern the case.

Inside, you'll find:

A complete walkthrough of the Two-Midnight Rule in traditional Medicare and Medicare Advantage
Operational guidance for the post-Inpatient-Only-list era, including the SNF three-day rule interaction
Plain-language analysis of every major 2026 patient notice form and transition deadline
Three peer-to-peer conversation scripts, ready to adapt for traditional Medicare, MA, and commercial payer denials
The five sentences every admission note should contain, and severity-of-illness markers for the eight most common medical admissions
A status decision tree, regulatory citations index, glossary, and sample UR plan language compliant with 42 CFR 482.30

Whether you're new to physician advisory work, leading a case management team, or running an entire UM department, this casebook gives you the regulatory framework, the operational discipline, and the documentation language that protect your hospital and the patients it serves.

Trusted for over 49 years

Family Owned Company

Secure Payment

All Major Credit Cards/Debit Cards/UPI & More Accepted

New & Authentic Products

India's Largest Distributor

Need Support?

Whatsapp Us

Related Category

medical > hospital administration & care

Bestselling

View All

Atomic Habits (Lead Title)

Clear, James

₹585

₹899

(-35%)

₹585

• Author(s): Clear | James • Publisher: Penguin • Publisher Imprint: Penguin Random House • Subject: General Books

Diary of a Wimpy Kid: Partypooper (Book 20)

Jeff Kinney

₹455

₹699

(-35%)

₹455

• Author(s): Jeff Kinney • Publisher: Penguin Random House Children's UK • Publisher Imprint: Penguin Random House Children's UK • BISAC: Comics & Graphic Novels - Humorous

Ikigai

Hector Garcia

₹390

₹599

(-35%)

₹390

• Author(s): Hector Garcia • Publisher: Penguin • Publisher Imprint: Penguin Random House • Subject: General Books

The Courage To Be Disliked How To Free Yourself Change Your Life And Achieve Real Happiness Courage To Series

Ichiro Kishimi

₹358

₹550

(-35%)

₹358

• Author(s): Ichiro Kishimi • Publisher: GROVE ATLANTIC • Publisher Imprint: Allen & Unwin • BISAC: Personal Growth - SuccessIchiro Kishimi lives in Kyoto. He writes, lectures and teaches in psychiatric clinics as a certified counsellor and c...

View full details

12 Years: My Messed-up Love Story

Chetan Bhagat

₹260

₹399

(-35%)

₹260

• Author(s): Chetan Bhagat • Publisher: HarperCollins Publishers India • Publisher Imprint: HarperCollins Publishers India • BISAC: GeneralFrom India's top-selling writer Chetan Bhagat comes a powerful new love story that will make you laugh, cry...

View full details

The Mountain Is You: Transforming Self-Sabotage Into Self-Mastery

Brianna Wiest

₹260

₹399

(-35%)

₹260

• Author(s): Brianna Wiest • Publisher: Manjul Publishing • Publisher Imprint: Amaryllis • BISAC: Body Mind And SpiritThis is a book about self-sabotage. Why we do it, when we do it, and how to stop doing it—for good. Coexisting but conflicting n...

View full details

The Art of Spending Money: Simple Choices for a Richer Life

Morgan Housel

₹290

₹499

(-42%)

₹290

• Author(s): Morgan Housel • Publisher: Pan Macmillan • Publisher Imprint: Pan Macmillan • BISAC: Finance - Wealth ManagementA third book from the International bestselling author of The Psychology of Money and Same as Ever, lessons on harnessing...

View full details

Mother Mary Comes To Me

Arundhati Roy

₹585

₹899

(-35%)

₹585

• Author(s): Arundhati Roy• Publisher: PRH INDIA LOCAL PRINT• Publisher Imprint: Penguin Hamish Hamilton• BISAC: Literary FiguresArundhati Roy’s first work of memoir, this is a soaring account, both intimate and inspiring, of how the author became...

View full details

Truth without Apology: A Guide for Those Who Can Stand It

Acharya Prashant

₹260

₹399

(-35%)

₹260

• Author(s): Acharya Prashant • Publisher: HarperCollins Publishers India • Publisher Imprint: HarperCollins Publishers India • BISAC: GeneralIn a world where vagueness is mistaken for depth and obscurity passes for wisdom, Truth without Apology ...

View full details

Grandma's Bag of Stories

Sudha Murthy

₹179

₹275

(-35%)

₹179

• Author(s): Sudha Murthy • Publisher: India Puffin • Publisher Imprint: India Puffin • BISAC: Short StoriesWho can resist a good story, especially when it's being told by Grandma? From her bag emerges tales of kings and cheats, monkeys and mic...

View full details

Days at the Morisaki Bookshop

Satoshi Yagisawa

₹260

₹399

(-35%)

₹260

• Author(s): Satoshi Yagisawa • Publisher: Bonnier Books Ltd • Publisher Imprint: Bonnier Books Ltd

Deep Work: Rules For Focused Success In A Distracted World

Newport, Cal

₹260

₹399

(-35%)

₹260

• Author(s): Newport, Cal • Publisher: Little, Brown Book Group • Publisher Imprint: Piatkus

Can We Be Strangers Again?: A National Bestseller

Shrijeet Shandilya

₹195

₹299

(-35%)

₹195

• Author(s): Shrijeet Shandilya • Publisher: Ebury Press • Publisher Imprint: Ebury Press • BISAC: Romance - GeneralIn the electric haze of college life, three friends are bound by laughter, late-night talks and unspoken promises. But when two of...

View full details

The Secret of Secrets: (Robert Langdon Book 6)

Dan Brown

₹975

₹1,499

(-35%)

₹975

• Author(s): Dan Brown • Publisher: Transworld Publishers Ltd • Publisher Imprint: Transworld Publishers Ltd • BISAC: Thrillers - EspionageDan Brown is the bestselling author of Digital Fortress, Deception Point, Angels and Demons, The Da Vinci C...

View full details

Magic of the Lost Temple

Sudha Murty

₹179

₹275

(-35%)

₹179

• Author(s): Sudha Murty • Publisher: India Puffin • Publisher Imprint: India Puffin • BISAC: Action & Adventure - General

Rich Dad Poor Dad: What the Rich Teach Their Kids about Money That the Poor and Middle Class Do Not!

₹390

₹599

(-35%)

₹390

• Publisher: Penguin • Publisher Imprint: Penguin Random House • Subject: General Books • BISAC: Personal Finance - GeneralApril of 2022 marks a 25-year milestone for the personal finance classic Rich Dad Poor Dad that still ranks as the #1 Pers...

View full details

World’S Greatest Books For Personal Growth & Wealth (Set Of 4 Books) : Perfect Motivational

Dale Carnegie, Napoleon Hill

₹390

₹599

(-35%)

₹390

• Author(s): Dale Carnegie | Napoleon Hill • Publisher: Fingerprint • Publisher Imprint: Fingerprint • Subject: General Books

The Housemaid: An Addictive Psychological Thriller With Mind-Bending Twists

Freida Mcfadden

₹358

₹550

(-35%)

₹358

• Author(s): Freida Mcfadden • Publisher: Penguin Select Print • Publisher Imprint: Penguin Select Publishing"Multi-Million Copy Bestselling Series •Now Being Made Into a Major Motion Picture Starring Sydney Sweeney and Amanda Seyfried #1 New Yor...

View full details

101 Tales: The Great Panchatantra Collection

Wonder House Books

₹390

₹599

(-35%)

₹390

• Author(s): Wonder House Books • Publisher: Wonder House Books • Publisher Imprint: Wonder House Books • BISAC: Comics & Graphic Novels - Fairy Tales, Folklore, Legends & MTimeless Wisdom, Talking Animals & Life Lessons for Young Min...

View full details

Man's Search For Meaning

Viktor E. Frankl

₹260

₹399

(-35%)

₹260

• Author(s): Viktor E. Frankl • Publisher: Random House • Publisher Imprint: Random Hou • Subject: Medical, Nursing and Health Sciences

Bacchon KI Doctor's Desi Parenting Book: A Doctor-Mom's Guide to Milk, Myths, Motherhood and More

Madhavi Bharadwaj

₹260

₹399

(-35%)

₹260

• Author(s): Madhavi Bharadwaj • Publisher: PRH India • Publisher Imprint: Penguin Ebury Press • BISAC: Parenting - MotherhoodWelcome to the wild, messy, wonderful world of parenting--where the nights are long, the diapers are explosive, and unso...

View full details

The Outsider

Vir Das

₹455

₹699

(-35%)

₹455

• Author(s): Vir Das • Publisher: HarperCollins Publishers India • Publisher Imprint: HarperCollins Publishers India • BISAC: Entertainment & Performing ArtsComedian and actor Vir Das is beloved (by some, tolerated by others, blocked by a few...

View full details

The Very Hungry Caterpillar

Eric Carle

₹293

₹450

(-35%)

₹293

• Author(s): Eric Carle • Publisher: Penguin Books, Limited (UK) • Publisher Imprint: Penguin Books, Limited (UK) • BISAC: Animals - Butterflies, Moths & CaterpillarsEric Carle's The Very Hungry Caterpillar is a perennial favourite with child...

View full details

Too Good to Be True : A smart, funny will-they-won’t-they romance by mostlysane

Prajakta Koli

₹260

₹399

(-35%)

₹260

• Author(s): Prajakta Koli • Publisher: Harper Fiction India • Publisher Imprint: Harper Fiction India • BISAC: Romance - ContemporaryWinner of the Amazon India Popular Choice Debut Book 2025 Award. From one of India's most-loved creators comes s...

View full details

Hospital Utilization Management: A Casebook on Medicare Two-Midnight Rule, Denials, Appeals, and Documentation for Physician Advisors and Case Manager

Related Category

Bestselling

Country

Country