Case Studies
Level of Care/Medical Necessity Review, 822-Bed Academic Medical Center
Customized Physician Advisor Support, 120-Bed University Affiliated Medical Center in California
Level of Care/Medical Necessity Review, 300-Bed Magnet Facility
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.
