• Utilization Management

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

Regulatory Insights

1135 Waivers: When do they expire?

1135 Waivers: When do they expire?

These waivers, known as 1135 waivers (due to being granted by Section 1135 of the Social Security Act), are allowed when 2 conditions are met: First, there must be a declaration of a Public Health Emergency (PHE) by the Secretary of the Department of Health and Human...

Regulatory Bulletins

Bulletin 01 – Inpatient Order Requirements

Versalus Health’s Comments on CMS’ Elimination of Burdensome Inpatient Order RequirementsIn the FY 2019 IPPS Final Rule (CMS-1694-F), which is scheduled to be printed in the Federal Register on 8/17/18, CMS finalized its proposal to remove the requirement that a...