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Medicare Basics and the Two-Midnight Rule

Juliet B. Ugarte Hopkins, MD, CHCQM-PHYADV

President, ACPA

Physician Advisor, Case Management, Utilization, and Clinical Documentation for ProHealth Care, Inc.

Dr. Juliet B. Ugarte Hopkins is a graduate of the University of Illinois College of Medicine and served as co-chief resident while in her Pediatrics residency at Advocate Lutheran General Children’s Hospital in Park Ridge, Illinois. Dr. Ugarte Hopkins practiced as a pediatric hospitalist for a decade and also served as medical director of pediatric hospital medicine and vice-chair of pediatrics at Rockford Health System in Rockford, Illinois before transitioning into her current role as the first Physician Advisor for Case Management, Utilization, and Clinical Documentation at ProHealth Care, Inc., a three-hospital, 575-bed health system in Southeastern Wisconsin.

Determining Status Outside of the Two-Midnight Rule (Non-Medicare Payors)


Government Affairs Committee Chair, ACPA

Physician Advisor, Atrium Health

Dr. Carolyn Dutton is board certified in Internal Medicine and Emergency Medicine. She completed medical school at St. George’s University School of Medicine and her training at Allegheny General Hospital where she served as Chief Resident. She has worked both in emergency medicine and as a hospitalist with Atrium Health since 2006. In 2016 she became the Medical Director for University City Wound Care Center. Dr. Dutton is also board certified in health care quality and management with a physician advisor sub-specialty by the American Board of Quality Assurance and Utilization Physicians (ABQAURP). She is Chair of the ACPA Government Affairs Committee and was a 2021 National Physician Advisor Conference (NPAC) Co-Chair.

The Physician Advisor Role in Clinical Documentation Integrity

Erica Remer, MD, CCDS

Clinical Documentation Integrity Committee Chair, ACPA

President, Erica Remer, MD, Inc.

After practicing emergency medicine for 25 years, Dr. Remer became the first physician advisor at University Hospitals Health System in Cleveland, OH. She served in the role of Clinical Documentation Integrity Advisor for 4 years, training 2700 providers in ICD-10. Along her career path, she got certifications in medical coding and as a clinical documentation specialist. Dr. Remer transitioned to independent consulting in July 2016. Although she loves helping identify documentation opportunity, her passion is educating coders, CDI specialists, and healthcare providers. She has authored numerous articles on CDI, coding, and denials, and is the co-host of Talk Ten Tuesdays, a weekly national podcast. For fun, she participates in ICD-10 Coordination and Maintenance Committee meetings.

Medicare Severity Diagnosis Related Groups (MS-DRGs)

Ahmed Abuabdou, MBBS, MBA

Vice President – Operations, ACPA

Assistant Professor, University of Arkansas for Medical Sciences

Ahmed Abuabdou, M.D., MBA is a practicing Hospital Medicine faculty at the University of Arkansas for Medical Sciences, Little Rock, Arkansas holding an academic rank of Associate Professor of Medicine. He serves as Associate Chief Medical Officer for UAMS Medical Center and leads its Physician Advisory Program. He serves as Physician Champion for the Clinical Documentation Integrity Program at UAMS Medical Center and is the Editor of the CDI Newsletter of UAMS "Concise is Nice" where CDI documentation tips are shared with faculty members, residents, and fellows. Ahmed is an active member of the CDI Education Committee of the American College of Physician Advisors (ACPA). Ahmed achieved board certification in Healthcare Quality and Management (CHCQM) with subspecialty certification as physician advisor by ABQAURP. He is also a certified clinical documentation specialist (CCDS) by ACDIS.

Condition Code 44 and Self-Denials,
Peer-to-Peers and Denials

Clarissa Barnes, MD, CHCQM-PHYADV, FACP

Vice President - Member Engagement, ACPA

System Physician Advisor, Avera Health

Dr. Clarissa Barnes is a board-certified internist who trained at Johns Hopkins for medical school and residency. She practiced as a traditional internist and a primary-care physician before starting her current work as a hospitalist at Avera McKennan in Sioux Falls, SD. She is a Lead Physician Advisor at Avera Mckennan as well as a system-level Physician Advisor for Avera Health, which reaches five states and includes over 1,000 physicians, nurse practitioners, and physician assistants.

Medicare Notifications

Alvin Gore, MD

Physician Advisor Survey Champion, ACPA

Director of Utilization Management, St. Joseph's Health

A Board-certified Family Physician with extensive experience in all aspects of Utilization Management, Dr. Alvin Gore has been performing the duties of a Physician Advisor since 2008. Having completed his training in Family Medicine at the Memorial Center in Johnstown, Pennsylvania, he has remained involved in medical education for a number of years as an Assistant Medical Director of Family Medicine Residency Program. He has been active in training Family Medicine residents and medical students, and has held academic appointments with a number of medical schools. Dr. Gore had significant experience with both inpatient and outpatient patient management, with a particular interest in Utilization Management aspects of hospital practices. Dr. Gore has added Physician Advisors' responsibilities to his academic position at the hospital, gradually expanding his range of duties. He has become a successful liaison between the CM Department and the medical staff.

Chairing the Utilization Management Committee

Benjamin Kartchner, MD, CHCQM PHYADV

The Learning Center Champion, ACPA

Essentials & Fundamentals Chair, ACPA

Associate Medical Director of Care Management, INW Region, Multicare Health System

Dr. Benjamin Kartchner is a board-certified Family Medicine physician; HCQM-certified by ABQAURP in 2019. After practicing hospital medicine full-time in Northern Idaho for and beginning his work as a physician advisor in 2018, he transitioned to a physician advisor role for MultiCare Health System in Spokane, Washington. This being a new role for MultiCare, he helped develop multiple facets of physician advisor work including utilization management, care management, CDI, and population health. He has since transitioned to a Care Management and CDI focus and is the Associate Medical Director of Care Management for the Multicare Health System covering the INW/Spokane region. He was the recipient of the ABQAURP Diplomate Achievement in 2021 for work related to COVID-19 Drop Teams and spoke about agile management at NPAC 2021. He is a practicing hospitalist since 2013 and is involved in educating student and resident physicians. He lives in Coeur d’Alene, Idaho on five acres with his wife and three children. Being a “hockey family, his self-described greatest accomplishment is, “building a 60x30 foot hockey rink on the property and winning the NPAC 2021 Quiz Bowl.”

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