Turning UM Data into Revenue Opportunities

Exploring the balance between care and cost

Turning UM data into revenue opportunities white paper

Utilization management (UM) data analysis transforms revenue cycle and care management practices, yielding greater earnings to support hospital and health system operations and sustainability while improving the timely delivery of quality care.

UM balances the delivery of the right care at the right time in the right setting. Providing the right, or medically necessary care, depends upon providing patients with treatment needed to achieve the best possible medical outcome without over- or under-utilizing services. The complexity of the cost structure in the U.S. healthcare system adds another hurdle. Even though medical necessity is the foundation upon which UM rests, it does not exist in a vacuum. It is intricately linked to cost. Achieving a utilization management balance can improve a hospital’s quality of care while at the same time reducing costs.

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