Denial Management
Utilization Case Review
We increase denial overturn rates and shorten revenue cycle
so you can provide the most appropriate and effective clinical care.
Second Level Case Reviews
Second Level or Admission Status Reviews include cases sent for clinical judgement to assess level of care or length of stay.
-
Payer Peer-to-Peer Reconsideration Reviews
Submission deadlines and lack of resources shouldn't prevent you from resolving medical necessity before the claim is submitted. Payer Peer-to-Peer Reconsideration Reviews recoup dollars by getting appeals overturned.
-
Medicare Short Stay Chart Audit Reviews
Short stay cases (hospital stays of less than two midnights) have a high probability of audit and outside scrutiny. Chart Audit Reviews reduce that probability.
-
Discharge Reviews
Our physician advisors use evidence-based, clinical determinations to review when inpatient hospital care ends.
-
Internal Peer-to-Peer Reviews
Benefit from peer-to-peer discussions initiated with the treating physician for case clarification, redirection to a lower level of care, discharge consideration or potential education. Part of our on-going education efforts, this is also included with second level reviews.
-
Appeal Reviews
Our physician advisors review denied inpatient stays and recommend appeals when appropriate.
Two physicians review every case.
CUSTOMIZED REPORTS
AppriseMD's customized, detailed reporting helps partner hospitals identify trends and determine root causes.
We customize our hospital partners’ quarterly reports to include things such as: insurance breakouts, case breakouts per day of week, appeal recommendations, number of cases redirected to higher or lower levels of care, peer to peer notes, education opportunities, clinical trends, successful appeals, and more.
We meet with our hospital partners throughout the year, and our quarterly reports include physician-driven documentation aimed at identifying root causes of denials.
Revenue Integrity Physician Advisory
We partner with hospital and health system utilization review teams of all sizes to identify denial root causes. Our payer-experienced, licensed, board-certified physician advisors facilitate hospital case reviews to maximize reimbursement and establish an immediate ROI.
Denial Management
Overturn your denials using our preparation, flexibility and payer-specific knowledge. Avoid denials utilizing Payer Peer-to-Peer Reconsideration Reviews prior to claim submission.
