We conduct a comprehensive chart review to determine the appropriate level of care. We use the same guidelines and clinical criteria as your patient's insurance provider to ensure accuracy. Our recommendations include clinical reasoning and criteria supporting our decision to help educate your utilization staff and physicians.
Peer to Peer Services:
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. Our success rate for peer to peer reviews is over 80% helping recover a substantial amount of reimbursement for you.
We provide full-time and part-time medical directorship positions to help your utilization management department with their day-to-day needs. Our medical directors are experienced at utilization management. Your institution will be assigned one medical director to help foster a collegial relationship with your staff. A backup medical director will be available when the primary medical director assigned to your hospital is unavailable providing you with a unique 24/7 access even for part-time positions. Schedule a virtual meeting with us to know more about this highly beneficial program.
How We Help
Enhance Your Service
We'll work with you to decrease your observation rates and length of stay.
Expert level of care reviews and peer to peer discussions to decrease denials.
Streamline workflows and educate your staff to help improve documentation.
Ensure CMS compliance so you are always prepared for RAC audits.
Tailored To You
Full-time and part-time utilization management directorships to support your utilization department.
Increase Profit Margin
Increase revenue and reduce costs through our affordable services.