Utilization Review

Doctor with mask and stethoscope. Hospitals need every financial advantage they can to recoup revenue from the pandemic.

With COVID-19, Hospitals Need Every Financial Advantage

As hospitals in some areas face a new and devastating round of COVID-19 surges, the financial impact on those hospitals is not yet known. This new spike in cases comes on the heels of more than 16-months of instability caused by the pandemic and just when hospitals were starting to make gains financially. According to […]

With COVID-19, Hospitals Need Every Financial Advantage Read More »

doctors in surgery

Eliminating the CMS IPO List will Continue to Complicate Hospital Stays

For an update on this issue, please read: CMS reverses course in inpatient only list   The Centers for Medicare & Medicaid Services (CMS) has begun to dismantle its inpatient only list, which has directed the level of care for more than 1700 procedures for physicians and hospitals since 2000. CMS said the move gives physicians

Eliminating the CMS IPO List will Continue to Complicate Hospital Stays Read More »

hospital staff discussing case

Utilization Review: In-House or Outsource?

Utilization management programs are often in-house services provided by hospital staff. However, more and more hospitals are outsourcing utilization review management as the pressure mounts to contain costs, especially following the COVID-19 pandemic, and improve care. Hospitals benefit from outsourcing utilization review in several ways, as it can: Free up in-house physician advisors and chief

Utilization Review: In-House or Outsource? Read More »

AppriseMD physician advisors provide essential utilization review and denial management services to hospitals

Documentation – A Key for Reduced Denials

There is one relatively easy way hospitals can reduce claims denials: better clinical documentation. Insurance companies require documentation, and it is often the leading factor in level of care and admission denials. The importance of providing complete documentation never goes away. Treating physicians and utilization review managers must ensure that every admission includes: All the

Documentation – A Key for Reduced Denials Read More »

admissions and perioperative / ICU directions sign in a hospital

A Quiet Shift that Could Shake Up Hospital Utilization Review

There is a seismic shift happening in Utilization Review: As of Saturday, May 1, 2021, UnitedHealthcare, the country’s largest healthcare insurance provider, is changing guidelines to adjudicate the level of care cases for hospitals from Milliman Care Guidelines (MCG) to InterQual.1 AppriseMD will be working closely with our current hospital clients to ensure this is

A Quiet Shift that Could Shake Up Hospital Utilization Review Read More »

Recouping revenue lost to COVID

Utilization Review Management Can Help Hospitals with COVID Revenue Loss

COVID-19 continues to have detrimental effects not only on health of people, but also on the economy and businesses in general. Included in these businesses are hospitals which have been expected to be fully supplied, staffed and ready to provide cutting edge care throughout the pandemic.  According to a new report released in February from

Utilization Review Management Can Help Hospitals with COVID Revenue Loss Read More »

hospital

Providing the Best Outcome for Patients Through UR

“The Hippocratic Oath is one of the oldest binding documents in history. Written in antiquity, its principles are held sacred by doctors to this day: treat the sick to the best of one’s ability, preserve patient privacy, teach the secrets of medicine to the next generation…” 1 As a physician-owned company in which board-certified physicians carry out

Providing the Best Outcome for Patients Through UR Read More »

Scroll to Top