UM / CM

Support Based on Your Needs

Utilization Management (UM) / Utilization Review (UR) hospital programs face several challenges that impact compliance and revenue integrity. CorroHealth has helped UM/UR program confronting:

Aggressive payer environments resulting in high level-of-care denial rates
Payer-affiliated hospitalists
High Observation rates
Insufficient data to hold physicians and payers accountable
Resource Intensive Processes
Limited tools/KPIs to measure UM/UR processes and outcomes
Expensive Physician Advisors outsourced program or needing support for internal programs

Support How You Need It

I have my own Physician Advisor Team

CorroHealth complements your Physician Advisor and Utilization Management teams by providing visibility and targeted expertise they need. Our solution allows your team to prioritize the cases with a high impact on compliance and revenue integrity and monitors outcomes to ensure optimal performance.

I DO NOT HAVE my own Physician Advisor Team

If you don’t have a Physician Advisor team or your team needs education or additional support, CorroHealth offers Physician Advisor services on a case review by case review basis or dedicated Physician Advisor Staffing services.

CorroHealth Can Help

The CorroHealth team of Strategic Advisors, Physician Advisors, Compliance, Regulatory, Managed Care, and Clinical Revenue Cycle experts can help:

Reduce Compliance Risk

 

by monitoring for outlier patterns, potential gaming, and to ensure high-risk cases are appropriately statused and billed to minimize risk of Medicare Contractor denials.

Reduce Observation Rates

for Medicare Fee-for-Service, Medicare Advantage and Commercial

Lower Medicare Fee for Service rates to match CMS/OIG expectations

Lower Medicare Advantage and Commercial rates to match benchmarks/contractual expectations

Provide Full Visibility into UM/UR Program

    Determine if cases were reviewed, appropriately status, and billed according to UM/UR process.

    Deliver Full Visibility into Payer Performance/Tactics

      Measure payer-specific performance across revenue cycle departments

      Detailed identification and explanation of payer tactics driving revenue loss

      Improve UM/UR Efficiency (or Streamline Processes or Operational Improvements)

        %

        reduction on Medicare Fee for Service manual reviews

        Significant reduction in cases requiring Physician Advisor review

        The CorroHealth Approach

        CorroHealth helps address the challenges UM/UR teams face by using a combination of data/analytics, education, and case-level interventions. The UM/UR program is combined with CorroHealth’s dedicated Strategic Advisor, who executes the action plan with the hospital UM/UR team.

        Assessment & Implementation

        • Using data analytics, staff interview, and assessments, identify the root cause of compliance risk and revenue loss

        Dedicated Strategic Advisor

        • This includes reviewing analytics, identifying operational vulnerabilities, making actionable recommendations, and implementing solutions

        Revenue Realization

        • Perform Physician Advisor Concurrent & Retrospective Case Reviews on high priority cases
        • Conduct Algorithmic & Audit Case Reviews on cases not requiring concurrent case reviews
        • Continuously Track Process to ensure the right cases are reviewed and expected outcomes achieved
        • Education & Process Modification based on data, audits, and trends. Trending to track progress includes calculating New Inpatient RealizationTM

        Revenue Preservation

        • Successfully Complete Peer-to-Peer and Written Appeals
        • Provide UM Feedback on appeal results to improve defensive documentation to avoid denials & improve results
        • Monitor UM/UR Process to constantly track and trend all program results to ensure process changes are being followed and resulting in the expected outcome
        • Payer Escalation working with Managed Care department; data & case examples
        • Treating Physician Escalation using data & case examples