Reduce denials, optimize reimbursement and shorten your revenue cycle with our team of licensed, board-certified denial management physician advisors experienced in payer and clinical settings.
Night, Weekend & Holiday Support
Positively Impact Your Revenue by Aligning Care Status Level to Mitigate Denials and Optimize Reimbursement.
Admitting patients requires complex medical judgement that we do not automate. Our value stems from the detailed quarterly data reports that augment our monthly data files, both of which offer complete transparency of our review process. This collection of data provides valuable insights into a hospital’s reimbursement practices, allowing for the identification and resolution of issues impacting payments. The redirection data shows prevented denials as well as the increased reimbursement resulting from cases where a higher LOC is recommended.
Physician Advisory Solutions
Our sole focus on denial management in utilization review allows our hospital clients to provide higher quality care with our timely turnaround times and medical necessity determinations. Education on clinical issues impacting denials, compliance and reimbursement are incorporated into our quarterly meetings, and all of our physician advisors are licensed and board-certified with experience in the clinical and payer settings.
Achieve excellence in utilization review by increasing your revenue and shortening your revenue cycle with accurate medical necessity determinations.
Hospitals and health systems utilize remote support to supplement their existing services. Hospital partners drive the parameters around cases escalated for review.
Physician advisors review all cases sent by hospital partners needing full-time support seven days a week, 365 days a year, including holidays.
Night, Weekend and Holiday Support
Hospitals must capture appropriate reimbursement and prevent denials to combat the rising cost of healthcare even on nights, weekends and holidays. Gap support services cover these hours, accommodating any physician advisor need.
Mitigate risk and optimize revenue even when your team is temporarily short staffed. We provide interim support when the need arises so you can focus on patient care every day.
Cases are never automated. Two physicians review every case.
Available Seven Days a Week, 365 Days a Year
Our services are provided year-round, including holidays, with turnaround time commitments for second level case reviews.
- LIVE coverage hours = 12 hours on weekdays; 8 hours on weekends
- Two-hour turnaround time during LIVE coverage hours
- Cases sent outside of LIVE coverage hours returned by noon the following day