Denials
Management
Contesting medical necessity and clinical validation (DRG) denials involves a meticulous review of denied claims, focusing on the accuracy of clinical documentation and the alignment with payor requirements.
Enhancing Care with Expert Advisors
Why Choose
Brundage Group?
Payor denials are increasing at an alarming rate and hospitals must be proactive in securing denials management support. Our organization has extensive subject matter expertise in denial resolution to ensure accurate reimbursement.
When claims are denied, timing is critical to determine whether there is merit for an appeal. With a focus on effective overturn rate, our Physician Advisors help hospitals quickly and effectively determine which cases to review, when to review the cases, and when to appeal.
Turning Denials into Approvals
Denial Analysis & Resolution
Our skilled team of Physician Advisors and denial management experts takes a meticulous approach to denial analysis and resolution. We understand that behind every denied claim lies a complex web of medical necessity requirements, contractual obligations, and payor tactics. We identify denial trends and root causes through in-depth analysis, allowing us to develop targeted strategies to prevent future denials. We are dedicated to overturning unjust denials and ensuring hospitals receive the accurate reimbursement they deserve.
Comprehensive ALJ & IRO Appeals Advocacy
Appeals Support
Navigating the appeals process can be complex and overwhelming, requiring a deep understanding of medical necessity and clinical validation denials. Our experienced Physician Advisors provide comprehensive support at all appeal levels. Beyond crafting appeal letters, we utilize evidence-based medical literature to substantiate the necessity of procedures, strengthening our appeals. From negotiations with Administrative Law Judges (ALJs) to engagements with Independent Review Organizations (IROs), we support hospitals every step of the way.
Expert ALJ & IRO Support
Specialized guidance and representation for medical appeals, ensuring strong support during ALJ hearings and Independent Review Organization reviews to secure favorable outcomes.
Evidence-Backed
Appeal Letters
Crafting persuasive appeal letters supported by strong medical evidence to effectively challenge denied claims and secure approvals.
Reliable Collaboration
Comprehensive Support Services
Peer-to-Peer Support
At Brundage Group, we believe in the power of peer-to-peer collaboration. Our Physician Advisors have completed thousands of successful peer-to-peer cases, gaining valuable insight into payor tactics and decision-making processes. We leverage this expertise to provide hospitals with robust peer-to-peer support, ensuring their voice is heard by payor medical directors. Through compelling arguments and evidence-based reasoning, we advocate for the medical necessity of procedures, ultimately securing the revenue hospitals have rightfully earned.
Contract Consultation
Contracts form the foundation of any relationship in healthcare, and understanding their nuances is crucial to mitigate payor tactics and protect hospitals’ interests. Our team of executive Physician Advisors, with their wealth of contracting experience, provides expert contract consultation services. We meticulously review key contract clauses, identify common pitfalls that are frequently missed, and discuss key contracting strategies with hospitals. By equipping hospitals with the knowledge and insights needed to navigate complex contracts, we ensure they are well-positioned for successful reimbursement while minimizing denials.
Tailored Solutions for Revenue Recovery
What Does Denial Management in Healthcare Entail?
Denial Management is vital for capturing hospital revenue and ensuring quality care. At Brundage Group, we recognize the impact of denials on hospitals’ financial health and patient care. Our services are tailored to address medical necessity denials by proactively identifying, analyzing, and resolving claim issues. By partnering with hospitals nationwide, we help maximize revenue recovery and maintain a healthy revenue cycle, supporting their mission to deliver exceptional care.
Services We Offer
We offer a comprehensive range of Denial Management Services tailored to meet the specific needs of our hospital clients. Our clinical expertise and experience enable us to provide effective solutions that streamline the appeals process, optimize overturn rates, and secure earned revenue.
Common Questions
Frequently Asked Questions
If you can’t find the information you need, please don’t hesitate to contact us. Our team is here to assist you with any questions or concerns you may have. Feel free to reach out to us for personalized support and guidance.
Request a Consultation
Unlock the Full Potential of Your Hospital’s Denial Management
Ready to enhance your hospital’s efficiency and patient care with expert Denial Management services? Our team at Brundage Group is here to help you reduce costs, improve outcomes, and streamline operations.
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