APPEALS AND DENIALS MANAGEMENT
A multi-disciplinary team comprised of professional in clinical medicine, government and insurance regulation, and coding and clinical documentation manages the appeal process and provides root cause analysis for denials to help prevent future occurrences.
REMOTE UTILIZATION REVIEWS
Utilizing nurse review criteria, remote utilization review specialists (RNs) provide the initial, concurrent or retrospective review of the medical record to determine if an ordered level of care is appropriate.
FOCUSED CHART AUDITS
Physicians perform retrospective batch audits focusing on clinical documentation and regulatory guidelines to find opportunities and make recommendations in the areas of admission status, medical necessity and length of stay.
ADMISSION STATUS REVIEW
Licensed physicians conduct admission status review supported by medical literature and in accordance with Medicare rules and regulations.
PAYER PEER TO PEER
Experienced physician advisors discuss and work to overturn concurrent commercial denials with payer medical directors.
CUSTOMIZED EDUCATION PROGRAMS
Physicians design and lead customized training programs for case management, physician advisors or attending physicians.