Hospitals today face increasing financial pressures, from shrinking reimbursements to rising operational costs. A critical yet often overlooked contributor to revenue leakage is inefficient utilization management (UM). Without real-time visibility and expert oversight, hospitals risk compliance violations, denied claims, and lost revenue from inaccurate patient status determinations.
Why Utilization Management is a Revenue Game-Changer
Proper utilization management enables hospitals to capture the revenue they’ve earned for the quality care delivered while maintaining compliance with ever-changing regulations.
Here’s how:
- Accurate Patient Status Determination – Ensuring patients’ status determinations are correctly assigned an inpatient or observation status from the start and throughout their continuum of care prevents revenue loss and future denials.
- Consistent Review Processes – Hospitals must review cases at the right time and with the right resources to optimize revenue capture.
- 24/7 Oversight – Gaps in UM coverage during nights, weekends, and staff transitions can lead to missed opportunities for proper reimbursement.
Hospitals risk losing money without a seamless and user-friendly tool—or worse, facing compliance penalties for incorrect billing.
Revolutionizing Utilization Management with Certus Radar™
Hospitals need tech-enabled clinical expertise to streamline UM and maintain revenue integrity.
That’s where Certus Radar comes in:
- Real-time compliance monitoring to meet evolving regulatory standards.
- Continuous 24/7 case reviews to prevent revenue gaps.
- Expert Physician Advisor oversight supports accurate patient status determinations.
- Actionable analytics to identify improvement opportunities in patient order processes.
With Brundage Group’s Certus Radar, hospitals nationwide are transforming their utilization management, capturing earned revenue, and confidently achieving compliance.
