A utilization review request doesn’t mean something went wrong. Often, it’s part of routine oversight to ensure accurate coding, medical necessity, and responsible use of Medicaid resources. Michelle Spanier, RHIT, CCS, CCEP, explains what hospitals should expect and how collaboration can turn reviews into stronger processes.
External peer review is not about finding fault. Michelle Spanier, RHIT, CCS, CCEP, explains how independent review helps small and rural hospitals protect patients, support providers and turn complex cases into opportunities for better care.
An insurance denial does not always mean the final answer is no. Michelle Spanier, RHIT, CCS, CCEP, explains how external review gives patients access to an independent, evidence-based evaluation of certain denied claims.
Access is not just about having information available. Tammy Elliott, RN, shares why real health care improvement means designing systems that people can actually understand, navigate and use when they need help most.
Small and rural hospitals face growing compliance demands with limited staff, time and resources. Michelle Spanier, RHIT, CCS, CCEP, explains why trusted partners can help strengthen processes, support patient care and ease the burden without adding bigger internal teams.
Tammy Elliott, RN, reflects on her journey from 27 years in a critical access hospital to statewide quality improvement work with KFMC, carrying the lessons of rural health care into every project she supports.
This session highlighted how Community Health Workers (CHWs) are being leveraged across Kansas to address complex community needs through cross-sector collaboration.
Independent review plays a vital role in today’s complex health care system. Michelle Spanier, RHIT, CCS, CCEP, explains how objective review protects patients, supports providers and strengthens trust through fair, evidence-based decisions.
What does nursing have to do with quality review? For Tammy Elliott, RN, everything. In this heartfelt reflection, she shares how one young patient shaped her career and why clinical thinking still matters far beyond the bedside.