Exploring effective denial management strategies makes a significant difference for a hospital’s bottom line. One key component that hospitals and health systems should no longer be overlooking is specialized physician advisors who can transform revenue cycles and ensure higher quality care while safeguarding revenue streams.
The latest and best solutions for improving revenue cycle and denial management include:
- Enhancing reimbursement through timely utilization reviews by physician advisors.
- Reducing denials with medical necessity determinations facilitated by physician advisors with experience in both clinical practice and utilization management.
- Improving overall revenue integrity with physician-driven discernment and analytics.
Enhancing reimbursement through timely utilization reviews by physician advisors:
Medical necessity determinations made by physicians experienced in utilization review improve efficiency. Second-level physician reviews, discharge assessments and Medicare short stay chart audit reviews are all conducted by expert physician advisors bringing the nuances needed to resolve denial issues. Hospitals can contract with AppriseMD for all their physician advisory needs, or on an as-needed basis to accommodate overflow and after-hours support. Additionally, white papers, case studies and detailed reporting analytics provided on a monthly and quarterly basis provide clinical insights that drive meaningful discussions to address care gaps and financial improvements with hospital and health system teams.
Reducing denials with medical necessity determinations:
Hospitals require comprehensive denial prevention and management that include peer-to-peer reviews with the payer medical director to overturn denials, appeal recommendations to determine the validity of the claim before resorting to a formal appeal and written clinical appeals to prevent denials and optimize reimbursement. Our denial management physician advisory team has experience in both clinical practice and utilization management, and our overturn rates yield exceptional returns on investment for our clients. We routinely publish case studies demonstrating how our services result in increased reimbursement, and our overturn statistics prove our value.
Improving overall revenue integrity with physician-driven discernment and analytics:
AppriseMD provides hospitals with a seamless approach to utilization review and management where clinical judgment, payer expertise and regulatory compliance are key attributes of our physician advisory team. Our physician-driven solutions capitalize on these skill sets which help our clients minimize denials and maximize reimbursement, as evidenced by the overturns our physician advisors obtain on difficult claims compared to our competitors. Examples of these overturns are published in our monthly case studies, as well as in our monthly and quarterly data summaries, which provide clinical insights that drive meaningful discussions to address care gaps and financial improvements.
Ask your team: “How is our organization countering the changes in healthcare costs and denial rates that are adversely impacting hospitals revenue?” If they need help exploring effective denial management strategies that make a significant impact on revenue, AppriseMD can help.