Utilization Reviews Simplified
We support hospitals by providing timely, expert review services by licensed, board-certified physicians. We work with your utilization department to offer conveniently available and accurate expert case reviews by utilization management trained physicians. We maximize revenue for community and private hospitals while ensuring compliance with CMS regulations through readily available, accurate, and affordable expert utilization review services.
We serve community & private hospitals
We provide expert utilization reviews to community and private hospitals that may not have the resources to have utilization management trained physicians at their disposal. Our expert physicians team up with your utilization department and come up with a comprehensive plan tailored to your individual needs.
We conduct regular audits and quality controls to ensure compliance with CMS regulations and managed care criteria.
We decrease your observation rate by providing accurate and timely utilization reviews, educating your staff to help improve documentation and decrease your length of stay. Our peer to peer service overturns your denials to maximize your revenue.
Yes, we comply with the different criteria used by Medicare, managed care and commercial carriers to determine the appropriate level of care.
Short stay patients can qualify for Inpatient based on clinical criteria.
Cases not on the inpatient only list are reviewed for eligibility for inpatient level of care on a case by case basis depending on co-morbidities and complications.
Yes, our physician reviewers are familiar with multiple EHR’s and can access your system to get the relevant patient information needed to complete utilization reviews.
We communicate with you through HIPAA compliant email.
All denials are reviewed against standard guidelines to determine the appropriate level of care. Cases meeting inpatient level of care guidelines are taken up for peer to peer reviews with the insurance medical directors.