• 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

Reimbursement Is Changing. Alignment Will Decide What Works
Reimbursement Is Changing. Alignment Will Decide What Works

Reimbursement Is Changing. Alignment Will Decide What WorksThe future of healthcare reimbursement is being driven less by any single policy and more by mounting pressures across the system. Costs keep rising, administrative complexity remains high, and patients bear...

New CMMI Models Signal a Seismic Shift for Hospitals
New CMMI Models Signal a Seismic Shift for Hospitals

New CMMI Models Signal a Structural Shift for HospitalsThe Centers for Medicare and Medicaid Innovation (CMMI) is reshaping how hospitals are paid, evaluated, and held accountable. The latest generation of payment models extends beyond incremental updates, increasing...

Regulatory Insights

COVID-19 CARES Act: Hospitals Must Proceed Carefully
COVID-19 CARES Act: Hospitals Must Proceed Carefully

By Jerilyn Morrissey, MD and Jay Ahlmer, CFA As COVID-19 case volumes continue to grow and hospitals prepare for an anticipated patient surge, the stress on healthcare facilities to weather an unprecedented health and financial crisis has skyrocketed. While the $2...

Improving Hospital Performance: A Counterintelligence Operation
Improving Hospital Performance: A Counterintelligence Operation

As payers become more sophisticated and aggressive in their audit and denial activity, many hospitals have struggled to keep pace. Operational silos and departmental driven metrics lead to disjointed, labor intensive, and ultimately unsuccessful efforts. These efforts...

Regulatory Bulletins

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