Hospital utilization review is a subspecialty that straddles both case management and revenue cycle. Historically the function has been managed with variable application of processes and consistency. This presentation is focused on a technology enabled framework to reduce fragmentation and variation in work product output while using machine based human assistance to augment productivity and accuracy. It will include a detailed model of a team-based approach to optimize patient account activities related to level of care determination, regulatory compliance, payer correspondence, authorization capture, physician advisor integration, interdepartmental communication, and payment recovery methods. The purpose of this presentation will be to share the structure for learning and application.

The framework has been implemented and tested to prove above average outcomes. Positive results for status determination turnaround times, level of care bed mix, denial rates, overall revenue recovery, and appeal overturn success metrics will be shared to reflect the benefit of this model use. Subjective benefits related to appropriate distribution of staff, working at the top of license, patient focused advantages, and ease of collaboration will be offered as well.

With the current environment of hospital reimbursement evolving to reduce cost utilization review teams need strategies to keep up with the times. Advanced and integrated technology with a team approach application has proven to outpace these developing changes.

Register online here: https://www.pathlms.com/cmsa/courses/112066

Free to Members | $40 Non-Members