The Varying Personalities Involved in UR

Adding humor to the clinical revenue cycle

I’d like to add a little humor to the reality of what really happens with physicians in dealing with the different components of clinical revenue cycle – specifically, utilization review (UR) specialists, case managers, clinical documentation specialists, and coders. I’m sure that you might identify with some of these following descriptions of scenarios and individuals involved in attempted physician communication, for answers to queries specific to the department (and I will use the term “case manager” as a generic):

  1. Successful discussion – probably happens more often than thought!
  2. The curmudgeon, which is defined as a bad-tempered, difficult, cantankerous person. That was me, and it was not uncommon for me to say “…and what medical school did you go to?” This usually did not result in a very productive conversation.
  3. The runner – this is the doctor who starts walking down the hall and spots a case manager ahead. They are thinking “They want to talk with me,” prompting them to run off in another direction. I’ve even seen them run into the OR, and they weren’t even a surgeon.
  4. The invisible man/woman – this is the doctor who makes rounds at 6 a.m. or after 9 p.m., just so they don’t have to see a case manager or discuss the case with anyone.
  5. The evader – in today’s world of technology, with various devices, texting, cell phones, and more ways to communicate, this person is not seen as much. Yet they do have ways of ignoring calls and texts (or saying “I never got it.”)
  6. The sneak – there are some facilities that do not require the attending to do a discharge summary for patients in observation. I was guilty of being a sneak. When ready to discharge an inpatient, I would change the status to observation and then write the discharge order. That way, the case manager could not have time to talk with me about the change. (Yes, I was a case UR nightmare.)
  7. The pleaser – essentially this is the doctor who says that he/she will do what is asked, and then goes ahead and does whatever they want.
  8. The collegiate – this is the doctor with whom there is actually great conversation, producing the information needed for an appropriate level of care or referral to a physician advisor.

In today’s world, with there being more physician advisors (PAs) around, they may run into similar situations, but not as many. Physicians can’t play as many tricks when it is a peer with whom they are talking. Doctors behave better then, but not always.


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