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Denial Management
Physician Advisor Services

to Optimize Reimbursement

Achieving excellence in utilization review to improve revenue cycle.

Optimize reimbursement, reduce denials and shorten your revenue cycle with our team of licensed, board-certified denial management physician advisors experienced in payer and clinical settings.

Improving Revenue & Patient Care Through Utilization Review Excellence

We focus on denial prevention to augment revenue integrity, allowing hospitals to provide higher quality care.

Timely Reviews

Compliments existing workflow for a seamless adoption

Reimbursement Resolution

Optimize reimbursement through physician advisory

Payer and Clinical Experience

Licensed & board-certified denial management physician advisors

Customized Reporting

Physician-driven documentation aimed at identifying denial root causes

Optimize patient care, reduce denials and maximize reimbursement through our unique approach to achieving excellence in utilization management.

Discuss your hospital’s utilization and denial management needs with our team.

 

AppriseMD is Physician Owned & Operated with
Utilization Review Physician Advisor Solutions that:

  • Increase reimbursement revenue through timely utilization review turnaround times
  • Reduce denials with medical necessity determinations facilitated by physicians with payer expertise
  • Reinforce revenue integrity with physician-directed discernment and healthcare analytics
  • Improve quality of care and length of stay with physicians skilled in exercising complex medical judgement
  • Enhance revenue cycle through excellence in utilization review
  • Increase compliance with a unified approached to utilization and denial management
  • Protect your revenue cycle by aligning care status to mitigate denials with physician advisor experts
%
of hospitals reported that the cost of
complying with insurer policies is increasing *
%
of appealed initial claim denials by
hospitals are ultimately overturned*

*American Hospital Association Survey: Commercial Health Insurance Practices that Delay Care, Increase Costs

Physicians discuss a medical case

Ensure appropriate level of care with our revenue integrity physician advisory solutions and optimize your revenue cycle.

Hospital Utilization Management Services

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    Second-Level Utilization Reviews

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    Payer Peer-to-Peer Reconsideration

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    Medicare Short Stay Chart Audit

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    Discharge Reviews

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    Utilization Review Education

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    Appeal Reviews

Physician Advisory

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    Remote Support

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    Full-Time Support

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    Night, Weekend & Holiday Support

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    Interim Support

More from AppriseMD

AppriseMD’s latest case study centers on a patient that was hospitalized for chest pain, and the claim was denied based on unproven medical necessity and a lack of reasonable expectation of hospitalization that crossed two midnights.
Case Study: Medical Necessity and Reasonable Expectations

CLINICAL SUMMARY: A 73-year-old patient’s primary care doctor sent her to the Emergency Department (ED) after multiple labs taken for continuing chest pains showed abnormal results. The patient, who had been suffering chest pain for more than a week and who was taking nitroglycerin, had a stent placed in April. […]

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Healthcare Insights

Addressing healthcare reimbursement, a focus on denial management and medical necessity from AppriseMD

 Read our new paper
Addressing Healthcare Reimbursement
A Focus on Denial Management and Medical Necessity

Blog

Hospitals should file a complaint when the Medicare Advantage (MA) plans do not follow the Two-Midnight rule
Hospitals should file a complaint when the Medicare Advantage (MA) plans do not follow the Two-Midnight rule

An American College of Physician Advisors’ (ACPA) recent report concurs with earlier data from AppriseMD that many Medicare Advantage Organizations (MAOs) are not complying with […]

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