Unlock higher
reimbursement.

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.

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Prevention is
profitable.

By providing precise and timely counsel, we help providers uncover the root cause of denials to optimize reimbursement.

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Continuous
improvement wins.

We help teams consistently improve quality and compliance using technology and best practices for clinical documentation, regulatory adherence and coding.

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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.

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The results will amaze you.

Increase reimbursement and proactively prevent denials.


CLINICAL DENIALS

RECOVERED.

Up to
68%

clinical denial recovery rate


COMMERCIAL DENIALS

OVERTURNED.

Up to
65%

success rate in payer peer-to-peer cases


TIME

SAVED.

Up to
30

minutes of staff time saved per case

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Learn how we transform the revenue cycle with solutions that streamline the
patient experience, drive operational efficiency and improve financial performance.