• Examine how hospitalist clinical documentation affects billing efforts and the hospital's revenue stream.
• Discuss the differences between utilization management and utilization review.
• Explore processes and techniques to revitalize a health system's utilization management programs.
• Recognize communication styles and techniques to make peer-to-peer communications successful.

This course is intended for Physicians of all specialties, Nurses, and Other Health Care Professionals with appropriate CME / CE credit offered for each profession.

All participants must achieve a final assessment score of at least seventy percent (70%) for recertification and continuing education credits. You have 60 days to complete the course after ordering.

This activity is valid from October 1, 2024 through September 30, 2027. Original presentation: September 12, 2024.

About the Authors:

Sogol Sepehri, MD, MBA, CHCQM
Vice President of Physician Advisors and Denials Medical Directors - HCA Healthcare

Dr. Sogol Sepehri currently serves as HCA’s Corporate Vice President of Physician Advisors and Denials Medical Directors. Previously, she was the Division Assistant Chief Medical Officer of HCA’s Central and West Texas (CWT) Division and Interim Chief Medical Office of North Austin Medical Center, St. David’s Surgical Hospital, and St. David’s Children’s Hospital. She initially joined HCA in 2018 as the Division Physician Advisor for the Austin and El Paso markets. She is a certified hospice medical director and is board certified with American Board of Quality Assurance and Utilization Review Physicians. Dr. Sepehri obtained her Master in Business Administration degree in 2021 from the University of Massachusetts Amherst and is in process of becoming a fellow of the American College of Healthcare Executives.

William J. Frederick Ill, MD, PhD, CHCQM-PHYADV
Physician Advisor Medical Director - Care Management I Social Work - Stanford Health Care

Dr. William James Frederick Ill is the Physician Advisor Medical Director at Stanford Health Care where he is redesigning their Utilization Management program. Prior to moving to Stanford in August 2023, Dr. Frederick was a Physician Advisor and Clinical Associate Professor of Medicine at UC San Diego Health. As an expert in Healthcare Quality Care Management, he led initiatives to start an internal physician advisor program, improve utilization management, reduce denials of service, improve patient flow, redesign General Inpatient Hospice workflow, develop quality and patient care initiatives in partnership with a critical illness recovery hospital, revamp and expand the health system charity policy, and implement multidisciplinary team rounding. As a medical educator, Dr. Frederick served as the Course Director for 4th year medical students during inpatient medicine rotations across four hospitals. As an Internal Medicine Core Faculty Member, he instituted a weekly quality improvement and patient safety conference. He provided ongoing education to faculty, staff, and trainees on topics of ethical use of hospice, critical illness recovery hospitals, patient flow, and quality management. His desire to give back to the community led him to service as faculty chair of the UCSD Faculty and Staff giving council.

Kathy Seward, MD, CHCQM-PHYADV
Physician Advisor - HPIR, LLC

Kathy is a physician consultant with over 20 years of industry and advisory experience in healthcare. Kathy’s current and past clients include both academic and community health systems. She works with clients to improve patient care, including physician engagement.
Her areas of expertise include medical necessity, level of care, progression of care, capacity management, physician practice patterns, over and under-utilization of resources, denials management, compliance with government regulations, and physician documentation requirements. Kathy has experience in both physician advisor education, coaching and mentoring as well as in assisting clients with implementation of programs related to denials management, physician documentation, medical necessity, and level of care.

Melissa Buchner-Mehling, MD, CHCQM-PHYADV, FABQAURP
Associate Chief Medical Officer Advisory Services - Sound Advisory Services

Dr. Melissa Buchner-Mehling finished Internal Medicine Residency and began practicing as a hospitalist in 2004. As an attending hospitalist, she was actively involved with many committees in the hospital, including the Patient Safety Indicator Committee, Ethics Committee, Utilization Management Committee, Readmissions Committee, and Throughput Committee. She also was the hospital ICD10 Physician Champion and CDI Physician Champion. As a hospitalist, she has volunteered for medical mission trips in Honduras and Kenya. Since her first days with Sound as a Medical Director of Advisory Services, Dr. Buchner-Mehling has found innovative ways to educate providers at the hospital. She is now the Associate Chief Medical Officer with Sound Advisory Services.

• Contact:
  Contact Education
• Training Hours: 4.00