Utilization Management Explained Utilization Management is also know as managing 'Bed Days.' When a patient with commercial health insurance is admitted to the hospital, the hospital is required to obtain approval from their health insurance company for payment. When the health insurance company approves the hospital stay, it only does so for a certain number of days. That number of days is determined by the clinical situation of the patients. For example, pneumonia may be approved for 3 days and a scoliosis surgery for 5 days. Only two companies in all of America set the standard for 'Bed Days.' Those companies are Interqual and MCG Care Guidelines. Interqual is owned by UnitedHealth Group and MCG Care Guidelines is owned by Hearst. $400B in inpatient healthcare spending is run through Utilization Management every year making Interqual and MCG Care Guidelines VERY POWERFUL companies. CORRECTION: The St. Louis newspaper is not owned by Hearst. Sources: https://www.changehealthcare.com/clinical-decision-support/interqual/level-of-care-criteria https://www.changehealthcare.com/clinical-decision-support/interqual/level-of-care-criteria#interqual https://www.doximity.com/pub/monique-yohanan-md https://www.bcbsnd.com/providers/news-resources/healthcare-news/2022-interqual-criteria-implementation https://www.mckesson.com/About-McKesson/Newsroom/Press-Releases/2017/McKesson-and-Change-Healthcare-Complete-the-Creation-of-New-Healthcare-Information-Technology-Company/ https://www.kff.org/medicare/issue-brief/traditional-medicare-spending-fell-almost-6-in-2020-as-service-use-declined-early-in-the-covid-19-pandemic/ https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.0481 https://www.mcg.com/care-guidelines/care-guidelines/ AHealthcareZ is 200+ Healthcare Finance Educational Videos. 💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthcare-money-campfire-stories-book AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health. 90,000+ Views Per Month Across All Platforms. Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.