The balance between quality of patient care and medical necessity is a top priority and the top concern of many healthcare organizations today. Due to rising healthcare costs, there has been a shift in the focus of reimbursement strategies that impact the delivery of patient care. This shift from a fee-based system to a value-based system creates a challenge that has shifted many providers' focus more directly on their revenue. As a result, organizations are forced to carefully consider the cost of the services they provide to patients and then determine whether the services and level of care are appropriate for the patient's prescribed care. Quality patient care is an ongoing effort that involves many different areas of healthcare. One area of ​​healthcare that is often used is utilization management. We read in John's that UM “is composed of a set of processes used to determine the appropriateness of medical services provided during specific episodes of care” (John,2011). Elements used to determine the appropriateness of care include the patient's diagnosis, location of care, length of stay, and other clinical factors. This system consists of three main functions aimed at improving patient care and controlling healthcare costs. These functions include utilization review, case management, and discharge planning. One source states that it also includes the process of denying claims and appealing (interviewee C. Jarvis, email communication, May 3, 2014). When used correctly, these UM processes can expedite patient care and reimbursement. It also demonstrates to third-party payers that the organization is taking steps to help control costs. This monitoring and management of patients' healthcare needs ensures... half of paper... that can be conducted by other trained professionals who will provide them with more time to dedicate to patient care. This use of HIM professionals in the UM process establishes a new area that organizations can leverage to improve patient care. Works Cited by the American College of Emergency Physicians. (2014, April). Usage Review FAQ. Retrieved from https://www.acep.org/Clinical---Practice-Management/Utilization-Review-FAQ/Jeffries, M. (2007, October). Usage review. How things work. Retrieved from http://health.howstuffworks.com/health-insurance/utilization-review.htmJohns, M. L. (2011). Health information management technology An applied approach (3rd edition). AHIMA PressMiller, J. (2013). Taxpayers reconsider usage costs. Managed Healthcare Executive, 23(11), 9-9,15. Retrieved from http://search.proquest.com/docview/1458614037?accountid=36202