Utilization Management
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.
Why Brundage Group
Internal physician advisors often do not have the expertise or resources to design, implement and manage programs effectively. Physician advisor programs supported by Brundage Group allow clients to leverage the expertise of our experienced physician advisors who are the industry leaders, as well as our proprietary analytics dashboard and case management software tracking solutions that set the standard for industry best practices.
Overturn Rate & Effective Overturn Rate
Contact us to learn about our unique and valuable approach to peer-to-peers and our successful overturn rate.
Overturn Rate & Effective Overturn Rate
Contact us to learn about our unique and valuable approach to peer-to-peers and our successful overturn rate.
How We Can Help
We provide compliant documentation education with each case review to equip physicians with the knowledge to appropriately and compliantly status patients. Our expert physician advisors help determine:
Which cases to review
When to review the cases
When to involve our advisors
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 immediately communicate the outcome back to our hospital client.
Industry Benchmarking and Technology Insights
We use proprietary data analytics to identify areas of opportunity in real time so your organization can quickly adapt to make changes that will immediately impact the revenue cycle.
Observation Review
The Critical Timeframe
Scrutiny is necessary as the observation hours increase. Failure to improve within the observation timeframe often supports the medical necessity of hospital inpatient admission. Observation patients should be reviewed frequently and escalation to a physician advisor should occur when appropriate. The physician advisor review will clarify when medical necessity is present for inpatient admission or discharge to ambulatory care is clinically appropriate. High-quality and timely communication with the attending physician and the utilization management nurse are paramount.
Effective case management is a key component to a hospital’s throughput
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).
Our high-quality, compliant, physician-based solution can support a model that works for your organization
Concurrent (in-house) case reviews
Observation, inpatient and continued/extended stay reviews
Retrospective (post discharge) case reviews
Proprietary analytics to optimize your healthcare system’s revenue cycle
Gap coverage nights and weekends
Denials management, including peer-to-peer and appeals support
Educational approach that includes compliant medical necessity documentation education
Proprietary analytics to optimize your healthcare system’s revenue cycle
Gap coverage nights and weekends
Denials management, including peer-to-peer and appeals support
Educational approach that includes compliant medical necessity documentation education
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.