Phoenix Medical Management, Inc

Meet Juliet B. Ugarte Hopkins, MD, ACPA-C, our Medical Director. Dr. Ugarte Hopkins brings a deep expertise in utilization management, case management, and clinical documentation to our team. Previously, she served as President of the American College of Physician Advisors (ACPA), founded Velvet Hammer Physician Advising LLC, and spent nearly a decade pioneering the physician advisor role in a three-hospital system. Before that, she was a pediatric hospitalist, medical director, and vice chair of pediatrics. A national speaker, author, and webcast contributor, Dr. Ugarte Hopkins continues to shape the future of physician advising. #PhysicianAdvisors #HealthcareLeadership #UtilizationManagement

Have questions about physician advisory services, utilization management, or case management strategies? We’re here to help! Whether you're looking for expert guidance or exploring new solutions, our team is ready to connect. Reach out today—your next step toward smarter, more effective hospital operations starts here! #PhysicianAdvisors #HealthcareLeadership #UtilizationManagement

CMS’s updated Conditions of Participation (CoPs) for obstetrical services are rolling out over the next two years, bringing significant changes to improve maternal health outcomes. Hospitals and Critical Access Hospitals (CAHs) must update: ? Staffing qualifications & training ? Emergency readiness protocols ? QAPI programs to address health disparities Now is the time to prepare! These changes aim to create safer, more equitable maternity care—ensuring hospitals meet compliance and deliver better outcomes for birthing patients. #MaternalHealth #CMSCompliance #QualityCare

?? New CMS Rules on Medicare Advantage Decisions ?? Too often, Medicare Advantage (MA) enrollees face coverage denials or inpatient-to-outpatient reclassifications without warning—leading to unexpected medical bills. CMS is proposing a crack down by requiring MA plans to notify enrollees immediately and allow appeals if financial responsibility changes. This move aims to protect patients from hidden decisions, ensuring fairness and transparency in healthcare. Will these new rules hold MA plans more accountable? Let’s discuss. ?? #MedicareAdvantage #PatientRights #HealthcareTransparency

Trump's executive order halts DEI programs, sparking confusion & clinic closures. What does this mean for healthcare access? Tiffany Ferguson, LMSW, CMAC, ACM, breaks it down. https://lnkd.in/gpzPHSvi #HealthcarePolicy #DEI #HealthEquity

Medicare Advantage (MA) plans, like Aetna, are increasingly denying readmission claims, raising concerns about transparency and data accuracy. These denials directly impact the Plan All-Cause Readmission (PACR) rate, a key quality metric that influences payer Star Ratings and financial bonuses. When claims are denied, readmissions may go unreported, creating a misleading picture of care quality. MedPAC reports suggest that many MA plans underreport readmissions, making their performance appear better than it truly is. This data gap has led to growing calls for stronger audits and increased transparency to ensure fair quality assessments and accurate reporting. As CMS evaluates these trends, the question remains—how can oversight be improved? Read more here. https://lnkd.in/g7KZKvwC #MedicareAdvantage #HealthcareTransparency #HospitalReimbursement

Understanding Patient Status vs. Patient Class: Why It Matters for Billing In hospital billing, patient status (Inpatient vs. Outpatient) determines reimbursement and compliance, while class refers to location or service categories—which don’t always align. Understanding these nuances is vital to avoiding billing errors and ensuring hospitals meet regulatory standards. Is your team clear on these distinctions? Let’s discuss! ?? #HospitalBilling #MedicareCompliance #RevenueCycle

Navigating Inpatient to Outpatient Reclassification: Key Changes Coming in 2025 Starting February 14, 2025, CMS has introduced a new process for Original Medicare beneficiaries reclassified from inpatient to outpatient observation, requiring hospitals to provide a Medicare Change of Status Notice (MCSN) for specific circumstances. This new CMS process introduces a new notice with nuanced parameters. ?? Medicare Part A & B: Patients that are Inpatient that are converted to Outpatient with Observation Services and have a length of stay greater than 3 days. – ??Medicare Part A only: Patients who are Inpatient converted to Outpatient with Observation Services will require this notice at the time of conversion with their Condition Code 44 notice. Understanding these updates ensures compliance and supports informed patient care. Are you prepared for these changes? Let’s discuss it! Phoenix is offering complimentary webinars on this new notice for anyone that is interested. Reach out today. ?? #HealthcarePolicy #Medicare #PatientRights #PhoenixMedical

Sara Williams,MSN,RN, ACM-RN Vice President of Clinical Strategy at Phoenix Medical, discusses the importance of starting the admissions process on the right foot. We’re committed to optimizing the admissions process to ensure that every patient receives the care they need—efficiently and effectively. ? #healthcareconsulting #casemanagement #carecoordination #utilizationreview #patientcare #healthcarequality #valuebasedcare #healthcarestrategy #medicalguidance #denialsprevention #denialsmanagement #utilizationmanagement

If you’re new here, we’re excited to introduce you to how we help healthcare organizations transform their case management, utilization review, and denials/appeals programs into a proactive, outcome-driven model. Our team is dedicated to improving both clinical and financial outcomes, and we are here to support your goals every step of the way. Here’s how we can help: ?? Assessment We assess your current processes to uncover strengths, weaknesses, and opportunities to improve care progression and financial results. [Learn more] ?? Partnership Collaborating with you to develop tailored programs and create a clear roadmap for success. ?? Improving We focus on boosting operational performance—reducing avoidable days, increasing capacity, and cutting down on denials. ?? Redefining We challenge traditional approaches, bringing in fiscally responsible techniques to optimize both clinical and financial outcomes. ?? Integrating Integrating the right people, processes, and technology for sustainable growth amid market challenges. Let’s ensure your program proves its value. Learn more about how we can help today! https://lnkd.in/g5xDz3fs ? #healthcareconsulting #casemanagement #carecoordination #utilizationreview #patientcare #healthcarequality #valuebasedcare #healthcarestrategy #medicalguidance #denialsprevention #denialsmanagement #utilizationmanagement