Revenue cycle teams have historically considered a certain amount of claims denials acceptable. Now, as margins shrink and the reimbursement climate is significantly more challenging, even a small percentage of denials can significantly impact financial performance.
Clinical denials require focus and clinician intervention. With more than 130 physicians on staff, R1’s Physician Advisory Solutions can help. We support physicians and case management by navigating the regulatory environment and providing concurrent recommendations to increase billing compliance and reduce clinical denials.
Concurrent reviews and written reports to support recommendations by licensed physicians in accordance with payor policies and regulations.
Experienced physician advisors work to overturn concurrent commercial denials with payer medical directors.
Appeals authored by a multi-disciplinary team of professionals in medicine, government and insurance regulation, leading to root-cause analysis to help prevent denials.
Case management or physician training programs, designed and led by physicians.
Initial, concurrent or retrospective reviews of medical records by RNs to determine if consistent with commercial criteria.
Retrospective batch audits by physicians to find opportunities and make recommendations in areas of admission status, medical necessity and length of stay.
No matter where you look in the healthcare revenue cycle, there are areas for improvement using technology and expert review and recommendation. The role of active and ongoing medical record review by utilization experts and physician advisors is still crucial at each step in the process to ensure maximizing compliant revenue. Download this whitepaper written by Dr. Ronald Hirsch on how clinical denials can be prevented with the development of a robust clinical denial prevention program.