1. Collaborating with the care team to confirm the patient is at the right level of care and ensuring best use of resources

2. Vanderbilt University Hospital (VUH) UM Team
UM Medical Director
Kevin Flemmons, MD, SFHM
Associate Hospital Director
William Fulkerson
RN Team Leads
Paula Glover RN, BSN
LaNora Gray RN, BSN
Physician Advisors
Daniel Biller, MD
Henry Jennings, MD
Allen Kaiser, MD
Walter Merrill, MD
David Walsh, MD
Rebecca Anderson, MD
Physican Advisors
Shelley Ellis, MD
Angela Horton, MD
Peter Paik, MD
UM Staff
20 – Day RNs, 2 – Weekend RNs
Appeals, AA, Office Assist

3. How UM nurses make a difference
Review patient charts for severity of illness, intensity of services and confirm correct status
Inpatient/Observation
Urgent/Emergent Admissions
Elective
Check authorization on the procedure
Correct status to match authorization
Ensure precert matches what patient is having done and when

4. Correct patient status is critical for billing
Inpatient
DRG (can bill for hospital services)
If patient does not meet criteria for inpatient admission, we cannot bill for our services
Observation
Fee for Service
Same as outpatient
Typically denied $ k/month due to incorrect status

5. We use criteria to determine if patient status
Observation
Inpatient
Are you “ruling out” then usually “remain observation!”
If patient diagnosis is listed as a symptom
Chest pain, abdominal pain, altered mental status
Severity of Illness/Intensity of Service
Blood products, IV abx, q1h neuro checks
2 midnight rule
Sometimes don’t have a diagnosis…that’s OK!

6. Documenting helps support reason for admission
What you see when you look at the patient
What we see when we read note

7. When to call us When we page you 
Seeking clarification on why we recommended a change in status
If you think the patient status is incorrect
If your patient needs SNF placement, does not meet a qualifying stay, and you have questions about why