{"product_id":"hospital-utilization-management-a-casebook-on-medicare-two-midnight-rule-denials-appeals-and-documentation-for-physician-advisors-and-case-manager-9798195384012","title":"Hospital Utilization Management: A Casebook on Medicare Two-Midnight Rule, Denials, Appeals, and Documentation for Physician Advisors and Case Manager","description":"\u003cp\u003e • Author(s): Fa Marcus T. Whitfield\u003cbr\u003e • Publisher: Independently Published\u003cbr\u003e • Publisher Imprint: Independently Published\u003cbr\u003e • BISAC: Hospital Administration\u003c\/p\u003e\u003cp\u003e\u003c\/p\u003e\u003cp\u003eThe 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.\u003c\/p\u003e\u003cp\u003e\u003ci\u003eHospital Utilization Management: A Casebook\u003c\/i\u003e 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.\u003c\/p\u003e\u003cp\u003eInside, you'll find: \u003c\/p\u003e\u003cul\u003e\n\u003cli\u003eA complete walkthrough of the Two-Midnight Rule in traditional Medicare and Medicare Advantage\u003c\/li\u003e\n\u003cli\u003eOperational guidance for the post-Inpatient-Only-list era, including the SNF three-day rule interaction\u003c\/li\u003e\n\u003cli\u003ePlain-language analysis of every major 2026 patient notice form and transition deadline\u003c\/li\u003e\n\u003cli\u003eThree peer-to-peer conversation scripts, ready to adapt for traditional Medicare, MA, and commercial payer denials\u003c\/li\u003e\n\u003cli\u003eThe five sentences every admission note should contain, and severity-of-illness markers for the eight most common medical admissions\u003c\/li\u003e\n\u003cli\u003eA status decision tree, regulatory citations index, glossary, and sample UR plan language compliant with 42 CFR  482.30\u003c\/li\u003e\n\u003c\/ul\u003e\u003cp\u003eWhether 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.\u003c\/p\u003e","brand":"Independently Published","offers":[{"title":"Paperback","offer_id":47882848600215,"sku":"9798195384012","price":3378.0,"currency_code":"INR","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0666\/3471\/1191\/files\/9798195384012.webp?v=1781097497","url":"https:\/\/atlanticbooks.com\/products\/hospital-utilization-management-a-casebook-on-medicare-two-midnight-rule-denials-appeals-and-documentation-for-physician-advisors-and-case-manager-9798195384012","provider":"Atlantic Books","version":"1.0","type":"link"}