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Revenue Integrity
Physician Advisory

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.

Timely Reviews
Consistency and Standardization
Regulatory Compliance
Optimized Reimbursement

Positively Impact Your Revenue by Aligning Care Status Level to Mitigate Denials and Optimize Reimbursement.

Physician advisors are skilled in navigating industry rules and regulations, assisting hospitals with education that factors into payer reimbursement while also providing a consistent approach to utilization review with increased accuracy. It is integral that health systems embrace a unified utilization review strategy that allows them to capitalize on commons goals that increase revenue, lower denials and contribute to an overall improvement in the quality of care and length of stay.

Optimize Revenue Cycle

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.

Turning UM Data into Revenue Opportunities

It is critical that utilization and revenue cycle managers actively and consistently review and analyze UM data to uncover strategies to achieve the best financial results. The data insights can be significant for a hospital’s reimbursement. Breaking down the data and reporting it into revenue buckets is one way to help simplify the analysis while also helping to provide a return on investment for physician advisor services rendered.

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Achieve excellence in utilization review by increasing your revenue and shortening your revenue cycle with accurate medical necessity determinations.

Determining observation stay guidelines

Timely Reviews

Hospitals and health systems utilize remote support to supplement their existing services to ensure timely reviews. When it comes to utilization management, time matters and can impact reimbursement. Hospital partners drive the parameters around cases escalated for review.

Doctor reviewing a patient chart on digital tablet in the hospital.

Consistency and Standardization

Working with an AppriseMD physician advisors full-time provides consistency and standardization across your utilization management process. Physician advisors review all cases sent by hospital partners needing full-time support seven days a week, 365 days a year -  including holidays - standardizing UM no matter the day or time.

Regulatory Compliance

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.

Optimize Reimbursement

Mitigate risk and optimize revenue even when your team is temporarily short staffed. We provide physician advisory 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

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.


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