Utilization Management and Clinical Documentation for Hospitalists


Accurate clinical documentation has never been more crucial. Hospitalists face a full spectrum of medical conditions in their careers. Regardless of a provider’s level of experience, the addition of new standards and policies, in both number and complexity, necessitate continued education. Utilization Management and Clinical Documentation for Hospitalists is an educational program on clinical documentation. It is broken into two modules. The first is a two-part didactic covering the fundamental principles of both utilization management and clinical documentation. The second is a module of six case studies that walks participants through common diagnoses in Hospital Medicine to illustrate clinical documentation and status determinations using the standard of medical necessity.


Hospitalists will be able to produce more accurate and comprehensive clinical documentation, which will help ensure quality patient care and proper reimbursement for the level of care provided.

Target Audience

This series is for any hospitalist physician, nurse practitioner or physician assistant who manages patients in the hospital setting.

Learning Objectives

By the end of this series, participants will be better prepared to:

  • Compare different patient status classifications and appreciate how this status can affect quality outcomes and cost burden to both patients and the hospital.
  • Recognize how improved clinical documentation can impact quality metrics both for the hospital and individual provider and affect appropriate reimbursement to reflect care rendered.
  • Identify principles of clinical documentation and patient status classifications learned and integrate them through clinical vignettes for medical necessity.

Release Date: April 27, 2021          Expiration Date: April 27, 2024

Interested in purchasing access for two or more providers?
Group purchases receive the member discount of more than 35% off per unit. To inquire please contact us at education@hospitalmedicine.org.

Course summary
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Utilization Management and Clinical Documentation for Hospitalists consists of two modules:

Module 1: The Basics
  • Part I: Utilization Management Basics
  • Part II: Medical Necessity and Clinical Documentation Basics
  • Module Quiz
Module 2: Case Studies
  • Session 1: Pulmonary & Infectious Disease
  • Session 2: Gastrointestinal & Renal
  • Session 3: Cardiology
  • Session 4: Neurology
  • Session 5: COVID
  • Session 6: Post-op Hip Fracture
  • Module Quiz
Content recorded and current as of March 2021

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit and MOC points.


The contents included in this presentation are for informational purposes only. The coding and documentation guidance provided herein does not replace the Official Coding Guidelines or professional judgment and expertise of the individual performing coding and documentation based on numerous factors including, but not limited to, documentation in the medical record, correct application of coding guidelines, and other industry recognized coding guidance. Coding guidelines and references are updated on an annual basis potentially impacting the accuracy of the content contained within this presentation. Reference official coding resources for up-to-date information. Neither SHM nor the speakers guarantee that the information supplied is without defect. Reasonable effort has been made to ensure accuracy, completeness, and relevance and to ensure that the educational information provided in this presentation is accurate and useful.


Associate Chief Medical Officer, Clinical Optimization and Revenue Integrity
Professor of Medicine, Loyola University Medical Center

Dr. Ansari reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

Christine C. Stallkamp, MD, FAAFP, CHCQM-PHYADV
Medical Director and Physician Advisor

Dr. Stalkamp reports having no relevant financial or advisory relationships with corporate organizations related to this activity.

The planners and faculty for this activity have no relevant relationships to disclose. All relevant relationships were mitigated prior to the start of this activity.

SHM Conflict of Interest Disclosure Policy 

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM mitigates all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

Speakers Disclosure

Both SHM and the speakers make no representation or guarantee with respect to the contents herein and specifically disclaim any implied guarantee of suitability for any specific purpose. The speakers and SHM have no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this material, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this presentation. The speakers and SHM make no guarantee that the use of this presentation material will prevent differences of opinion or disputes with Medicare or other third-party payers.

Accreditation Statement

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Statement Designation

The Society of Hospital Medicine designates this activity for a maximum of 7.00 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 7.00 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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Member cost:
Your cost:
Please login or register to take this course.

Interested in purchasing access for two or more providers?
Group purchases receive the member discount of more than 35% off per unit. To inquire please contact us at education@hospitalmedicine.org.