Our Physician Advisory Solutions help physicians and case managers navigate the regulatory environment to ensure an increase in billing compliance and a reduction in clinical denials.
Revenue cycle teams face shrinking margins and an increasingly challenging reimbursement climate such that even a small percentage of denials can significantly impact financial performance. We can drive revenue optimization in the following areas:
Utilization review specialists (RNs) provide the initial, concurrent or retrospective medical record reviews to confirm the appropriate level of care.
Licensed physicians conduct level of care reviews supported by medical literature and in accordance with Medicare rules.
Physicians perform retrospective audits based on clinical documentation and regulatory guidelines to make recommendations for admission status, medical necessity, physician documentation and length of stay.
Experienced physician advisors work actively with payer medical directors to overturn concurrent commercial denials.
A multi-disciplinary team manages the appeal process and provides denial root-cause analysis to help prevent future occurrences.
Physicians design and lead customized training programs for case management, physician advisors and attending physicians.
Increase reimbursement and proactively prevent denials.
clinical denial recovery rate
success rate in payer peer-to-peer cases
minutes of staff time saved per case