A non-profit hospital faced a tough decision when their Accounts Receivable (AR) vendor failed to perform, leaving a backlog of small balance accounts aged between 180 to 210 days.
Clinically Aligned Status Decisions. Financially Sound Outcomes.
Reduce administrative burden and avoid costly missteps with a utilization management strategy built for speed, precision, and alignment.
- 23% Average Payment Increase per Medical Case
- 40% Fewer Physician Advisor Concurrent Reviews
- 60% Reduction in Concurrent Patient Status Reviews
- 50% Decrease in Observation Rates
UTILIZATION MANAGEMENT
Leveraging advanced data analytics with clinical expertise to strategically and compliantly combat payer denials
Physician Advisory
Strategic and programmatic approach to transform team performance
Analytics as a Service
Align critical metrics to your revenue goals
Admission Status Reviews
Proprietary data-driven review program to optimize patient admission status
Peer-to-Peer Reviews
We defend your patient care choices to secure fair reimbursement
Denials Management
Root-cause analysis and strategy to combat payer tactics
UM Resources
Turning AI Promise Into Real Progress in Healthcare
How to Turn AI Promise into Real Progress in Healthcare AI adoption in healthcare has accelerated, but the gap between enthusiasm and practical results is still wide. As health systems move into 2026, leaders are shifting their attention from theoretical potential to...
Rethinking Healthcare Documentation and Denials for a Better Future
Rethinking Healthcare Documentation and Denials for a Better Future Healthcare organizations are moving through one of the most difficult administrative periods the industry has ever seen. Denials are rising, documentation requirements keep expanding, and...
Build a Stronger Bottom Line with our Hospital Budgeting Toolkit
Build a Stronger Bottom Line with our Hospital Budgeting Toolkit Budget season can put health system leaders in a difficult spot. Costs must come down and every dollar has to be justified. But with denials rising, payer demands intensifying, and patient needs growing...
Regulatory Insights
Vulnerabilities Remain Under Medicare’s 2-Midnight Policy
In 2016, the Office of the Inspector General (OIG) published a report, “Vulnerabilities Remain Under Medicare’s 2-Midnight Policy”, summarizing the first findings of hospital billing patterns since the implementation of the Two-Midnight Rule. The results surprised...