Utilization Management

Each review includes medical necessity documentation education to ensure compliance with established criteria. This supports healthcare providers in meeting documentation requirements and fosters understanding of medical necessity standards, leading to better patient outcomes and optimized healthcare resource use.

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Protecting Revenue Through Compliance

Compliant Patient Status
That Protects Revenue

Payors are increasing efforts and utilizing various tactics to deny inpatient level of care. To effectively mitigate these efforts, it is essential to utilize Physician Advisors who have experience and expertise in combating payor tactics. We support hospitals and physicians with timely and compliant expert status determinations.

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Why Brundage Group
Observation Review
Benefits
Important Resources

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Enhancing Care with Expert Advisors

Why Brundage Group?

Brundage Group provides expert Physician Advisors and along with proprietary analytics and case management software, to ensure best practices and optimal outcomes.

Our expert Physician Advisors help determine:

Which Cases to Review:

Our advisors identify which cases are most critical or complex, ensuring that reviews are focused on areas where accurate documentation is essential for compliance and patient care.

When to Review the Cases:

We help determine the ideal timing for reviewing cases, balancing clinical workflows and compliance needs to ensure timely and effective documentation practices.

When to Involve Our Physician Advisors:

Consult our expert Physician Advisors for complex cases, second opinions, or key clinical decisions. Ideal for reviewing challenging diagnoses, treatment plans, or best practices.

Reliable Collaboration

Peer-to-Peer Support

We have interacted with payors on thousands of peer-to-peer cases and have established valued, credible relationships with many of the health plan medical directors. Our extensive experience & expertise allow us to recommend which cases to proceed with during the peer-to-peer stage and generate an effective overturn rate for our clients.

Once a peer-to-peer is requested, we contact the payor within 24 hours to coordinate and resolve a peer-to-peer review, and promptly communicate the outcome back to our hospital client.

Technology-Driven Revenue Solutions

Industry Benchmarking
& Technology Insights

With thousands of completed cases, we track data to help hospitals measure performance against industry benchmarks and provide recommendations based on best practices. Our proprietary analytics identify real-time opportunities, enabling your organization to swiftly implement changes that positively impact the revenue cycle.

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Capturing Revenue with Utilization

Our clients see a positive impact on revenue with our utilization management support ensuring accurate reimbursement for the high-quality care provided to the community.

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Enhancing Case Management Efficiency

Observation Review

Doctors discussing utilization management with records

A Critical Timeframe
is Key to Accurate Patient Care Decisions

Increase observation scrutiny over time. Lack of improvement may justify inpatient admission. Frequent reviews and Physician Advisor escalation determine if admission or discharge is appropriate.

Communication with the care team is essential.

Effective Case Management is a Key Component to a Hospital’s Throughput

Our Physician Advisors act as liaisons between hospital case management departments and attending physicians to help render opinions regarding utilization of resources, continued stay and admission status based on sound medical judgment.

We promote physician efficiency and strengthen communication between providers and case management with the goal to make hospitals more efficient and optimize the length of stay (LOS).

Significance of
Case Management

Effective case management is crucial in modern healthcare, linking finance and clinical teams and coordinating resources from admission to discharge for optimal patient outcomes.

Streamlining Patient Journeys
Optimizing Resource Allocation
Holistic Care Coordination
Patient Advocacy
Financial Responsibility

Tailored Solutions for Revenue Cycle Success

Our Compliant, Physician-Based Solution Supports Your Organization’s Model

Our compliant status determinations are performed by experienced Physician Advisors and include medical necessity education. Overwhelmed with denials? We can also help manage payor denials to protect revenue. Our Physician Advisors are experienced in working with all payors and apply best practices to succeed on appeal.

Concurrent Case Reviews

In-house evaluations of current patient cases.

Observation Reviews

Assessments for observation, inpatient, and extended stays.

Retrospective Case Reviews

Assessments for observation, inpatient, and extended stays.

Gap Coverage

Coverage and support during nights and weekends.

Revenue Cycle Analytics

Tools to enhance your healthcare system’s revenue cycle.

Denials Management

Comprehensive support including peer-to-peer and appeal processes.

Educational Support

Training on compliant documentation for medical necessity.

Ready to enhance your clinical
revenue cycle?

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Protecting Revenue from Care Level Errors

What is Improper Level
of Care Costing You?

Insurance companies have a team of people working to protect their revenue, and so should you. Improper level of care may be costing your organization thousands of dollars per admission. Our expert Physician Advisors base all status determinations on sound medical necessity criteria with effective documentation to ensure accurate reimbursement for providing high-quality care.

FAQs

Important Resources

Why is Utilization Management Important?

Utilization management plays a crucial role in revenue management and optimization for hospitals.
It is vital for several reasons:

Optimizing Resource Allocation

Utilization management helps hospitals make informed decisions about resource allocation. By ensuring that resources, such as hospital beds, diagnostic tests, and surgical procedures, are used efficiently and judiciously, hospitals can maximize their capacity to treat patients in need.

Cost Control

Healthcare costs continue to rise, and effective utilization management is essential for controlling expenses. By reviewing the appropriateness and medical necessity of services, Utilization management helps identify unnecessary or inappropriate care, reducing wasteful spending and mitigating financial strain on patients and healthcare providers.

Enhancing Patient Safety and Quality of Care

Utilization management promotes providing high-quality care by ensuring that patients receive the right care at the right time. Potential risks and adverse events can be identified through the review process, and appropriate interventions can be implemented to enhance patient safety and improve clinical outcomes.

Compliance and Risk Mitigation

Utilization management helps hospitals comply with regulations and guidelines set forth by regulatory bodies and payors. Hospitals can minimize the risk of audits, denials, and potential legal repercussions by ensuring that services are delivered within established medical necessity criteria and documenting the rationale for care.

Revenue Optimization

Proper utilization management is directly linked to revenue optimization for hospitals. By accurately documenting medical necessity, improving coding and billing practices, and minimizing denials, hospitals can capture appropriate reimbursement for the care they provide. This supports financial stability and enables hospitals to invest in improving patient care and expanding services.

The Goals of Utilization Management

Brundage Group recognizes that the goals of utilization management are pivotal for driving revenue and optimizing healthcare operations. Our comprehensive solutions align with these goals to ensure hospitals achieve optimal outcomes.

Ensuring Medical Necessity

At Brundage Group, we prioritize ensuring providers can accurately demonstrate medical necessity. Our experienced Physician Advisors collaborate with hospital staff to carefully evaluate the clinical appropriateness of services and procedures. By adhering to evidence-based guidelines and industry best practices, we help hospitals ensure that the care provided is medically necessary, improving patient outcomes and supporting accurate reimbursement.

Enhancing Quality of Care

We passionately believe that utilization management should focus on enhancing the quality of hospital care. Through our comprehensive services, including clinical documentation education and peer-to-peer support, we enable hospitals to achieve excellence in care. By identifying opportunities for improvement and implementing best practices, we empower hospitals to deliver high-quality, evidence-based care that exceeds industry benchmarks.

Controlling Healthcare Costs

Brundage Group understands the critical role utilization management plays in controlling healthcare costs. Our solutions help hospitals minimize unnecessary or inappropriate services, reducing wasteful spending and optimizing resource allocation. By carefully assessing the medical necessity and appropriateness of care, we enable hospitals to make informed decisions that drive cost savings without compromising patient safety or quality of care.

Improving Patient Outcomes

The ultimate goal of utilization management is to improve patient outcomes, and this is a core focus at Brundage Group. Through our expert Physician Advisors and comprehensive case management support, we enhance patient safety, promote timely interventions, and optimize treatment plans. By ensuring that patients receive the right care at the right time, we contribute to improved clinical effectiveness and positive patient experiences.

Revenue Optimization

Brundage Group recognizes that revenue optimization is a fundamental goal of utilization management. We work closely with hospitals to ensure accurate reimbursement for the high-quality care they provide to their communities. Our proprietary analytics, benchmarking data, and expertise in managing payor denials help hospitals protect their revenue and maximize appropriate reimbursement. By optimizing coding and billing practices, we empower hospitals to achieve financial stability while maintaining compliance with regulatory guidelines.

At Brundage Group, we are committed to helping hospitals achieve these goals. Our comprehensive services, knowledgeable Physician Advisors, and advanced technology solutions ensure that hospitals can successfully drive revenue, enhance patient care, and maintain financial sustainability. By partnering with us, hospitals can confidently navigate the complex landscape of utilization management, knowing they have a trusted and experienced ally.

Additional Support Details

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.

How does Brundage Group support hospitals in utilization management?

At Brundage Group, we offer comprehensive utilization management solutions tailored to the specific needs of hospitals. Our services include Physician Advisor programs, documentation education, peer-to-peer support, industry benchmarking, technology insights, observation review, and effective case management support. We provide expert Physician Advisors who collaborate with hospital staff to ensure compliant and appropriate status determinations, optimize resource utilization, and streamline communication between providers and case management.

How does Brundage Group help hospitals in revenue protection?

Our Physician Advisors are experienced in working with commercial payors and applying best practices to succeed on appeal. We help manage payor denials, protect revenue, and capture appropriate reimbursement for providing high-quality care. Through our proprietary data analytics, we identify areas of opportunity in real-time, enabling hospitals to adapt quickly and make changes that immediately impact the revenue cycle.

What makes Brundage Group stand out in utilization management?

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Unlock the Full Potential of Your Hospital’s Utilization Management

Ready to enhance your hospital’s efficiency and patient care with expert Utilization Management services? Our team at Brundage Group is here to help you reduce costs, improve outcomes, and streamline operations.

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Utilization Management

Compliant Patient Status
That Protects Revenue