In the Chicago area, when it seems like the most challenging aspects of the pandemic seem to be behind us, the roller coaster rise and fall in cases of the pandemic continue. While hospitals are struggling to rebound from the economic impact of the pandemic, they are also looking at opportunities.
Administrators may have to decide where outsourcing fits best in their budget rather than handling certain services in house. Utilization Review is a useful and relevant tool to help hospitals manage the comeback. We are working with our current clients to step up services such as leveling of care, peer-to-peer reviews and supporting whatever other needs arise.
If a hospital is not receiving the support it needs from its utilization review partner, it may be time to look at other options. The relationships we have with our client hospitals and the flexibility within our service model allows us the opportunity to say, “What do you need?” Our clients’ answers give us the opportunity to find customized solutions from our clinical experts.
We recently completed a small pilot P2P case study for one hospital with a small number of denied short inpatient hospital says determined to be “hopeless” in terms of getting an overturn decision from the insurance carrier. With attention to detail, we conducted peer-to-peer reviews and saw 8 cases overturned. A second larger study is underway and is showing a 53% overturn rate to date. These cases likely would have never been addressed by the busy attending physicians yet resulted in a significant revenue boost to the hospital. Successful level of care denial overturns are a significant source of additional funding for hospitals struggling to recover economically.