Our commercial insurance denials service overturns 89% of cases at the peer-to-peer stage.

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Case Studies

Level of Care/Medical Necessity Review, 822-Bed Academic Medical Center

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Customized Physician Advisor Support, 120-Bed University Affiliated Medical Center in California

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Level of Care/Medical Necessity Review, 300-Bed Magnet Facility

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Results

Peer-to-Peer Denials Assistance

BMG’s commercial insurance denials service overturns 89% of cases at the peer-to-peer stage. In the majority of the remaining denials, when the circumstances do not meet inpatient criteria, a peer-to-peer review is successful in establishing cause to rebill the cases as observation.

CC and MCC Capture / CMI Results

BMG educates physicians on proper inpatient documentation to create better CC and MCC capture rates and improve case mix index (CMI). Our clients’ results include 10% improvement of CC and MCC capture rates; and a CMI increase to a record high of 2.0 for one Florida hospital group. CMI increased at an LTAC client by 0.29 in just one month following Dr. Brundage’s on-site physician education.

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