Timely and remote screenings from certified nurse professionals help ensure compliance, coordinate care and streamline the utilization review process.
Cutting through the complexities of utilization review is vital for maintaining compliance and optimizing patient care, but it can place a heavy burden on healthcare team s.
That’s where the R1 Utilization Review, part of our Physician Advisory Solutions (PAS), can help. With certified nurses and proven processes, we deliver timely, criteria-driven remote utilization reviews that support the coordination of care, bed management, discharge planning and compliance with Conditions of Participation.
Ensure compliance. Improve patient experiences. Meet high standards.
We deliver a flexible, cost-effective approach that supports clinical integrity while improving the patient experience. R1’s Utilization Review delivers remote screenings for both concurrent and retrospective reviews, giving providers confidence that they’re maintaining compliance.
Here’s how our solution helps improve operations:
Remote utilization review.
Criteria-driven nurse reviews for admission status and continued stay evaluations.
Admission status review.
Compliant physician level of care reviews, based on the most current clinical information.
Peer-level conversations.
Physician-to-physician discussions with payer medical directors can overturn concurrent inpatient or outpatient denials.
Clinical appeals.
Comprehensive appeals and denials management, along with resolution and prevention for all types and levels of clinical denials.
Chart audits.
Batch audits for clinical documentation, length of stay, regulatory guidelines, coding and more.
Post-discharge and concurrent support.
Education, root cause analytics and customized process improvements for providers.
Why healthcare organizations choose R1
Our clinical utilization review services are backed by expertise and tangible results:
- Experienced talent. Dedicated clinical experts ensure timely and compliant reviews.
- Measurable performance. We help reduce denials and improve reimbursement rates.
- Regulatory confidence. Ongoing education keeps customers’ teams aligned with changing compliance regulations.
- Root-cause insights. We help uncover trends to provide insights and drive revenue.
Realize value with end-to-end clinical solutions
R1’s Utilization Review is one element of our full PAS suite.
Discover how the R1 Utilization Review helps with reviews while ensuring compliance.
Payer peer-to-peer.
Direct physician-to-physician interaction with payer medical directors to overturn concurrent denials.
Clinical appeals.
Comprehensive appeals management for all clinical denial types and levels.
Admission status review.
Advanced technology and deep audit expertise optimize hospital billing.
