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.
We help teams consistently improve quality and compliance using technology and best practices for clinical documentation, regulatory adherence and coding.
"R1 has been an enormous help to us by providing services to supplement our internal Physician Advisory Program. During COVID-19, we had to shift resources into other areas, and they have been able to quickly and efficiently meet our needs."
Darla Easley, RN, MSN, NE-BC Sr. Director Case Management & Service Lines, North Kansas City Hospital
Unlock root cause of 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:
Remote Utilization Reviews
Utilization review specialists (RNs) provide the initial, concurrent or retrospective medical record reviews to confirm the appropriate level of care.
Admission Status Review
Licensed physicians conduct level of care reviews supported by medical literature and in accordance with Medicare rules.
Focused Chart Audits
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.
Payer Peer-to-Peer
Experienced physician advisors work actively with payer medical directors to overturn concurrent commercial denials.
Appeals and Denials Management
A multi-disciplinary team manages the appeal process and provides denial root-cause analysis to help prevent future occurrences.
Customized Education Programs
Physicians design and lead customized training programs for case management, physician advisors and attending physicians.
Supercharge the revenue cycle.
R1 Intelligent Automation fuels our ability to deliver differentiated value – reduced cost and waste, greater profitability and a better patient experience.
Increase reimbursement and proactively prevent denials.
CLINICAL DENIALS
RECOVERED.
Up to
68%
clinical denial recovery rate
COMMERCIAL DENIALS
OVERTURNED.
Up to
79%
success rate in payer peer-to-peer cases
TIME
SAVED.
Up to
30
minutes of staff time saved per case
Ready to talk?
Learn how we transform the revenue cycle with solutions that streamline the patient experience, drive operational efficiency and improve financial performance.
