A Utilization Management partnership that results in accurate patient status and increased revenue

The shift to value-based  & patient-centered care has made it vitally important to ensure that your organization has an effective utilization management plan that can save you time wasted on inaccurate patient status and improve reimbursement. 

Our utilization management services work directly with your case management program leaders, case management staff, revenue cycle team, and physicians to develop and implement a successful and robust utilization management workflow that supports the correct patient status at the time of admission. We conduct continued stay reviews to verify that the patient continues to meet medical necessity. These robust utilization reviews have helped hospitals and health systems improve care efforts throughout their organization, significantly reduce denials, and increase net revenue.

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During the pandemic when our health system faced workforce challenges, McBee Care Management & Utilization Review Services helped streamline our operations and supplement our workforce capacity for emergency department admission and pre-operative reviews. Within just two weeks, McBee seamlessly became an extension of our team and resolved critical gaps to help us ensure our patients receive the appropriate level of care in the right setting at the right time.

Michael Talley, Vice President, Clinical Operations & Virtual Care , CHRISTUS Health

The McBee Advantage

Actively managing patient status at the point of admission is critical to ensure proper reimbursement, reduce the risk of a denial, and identify opportunities for conversion to inpatient status prior to the first midnight. Our utilization review team verifies that documentation meets (or supports) medical necessity requirements utilizing hospitals’ approved evidence-based criteria and by collaborating with the providers for any additional supporting documentation. Initially identifying accurate patient status results in reduced risk of denials, improved observation rates to be more reflective of the care provided, actively managed length of stay, which results in additional revenue. 

Paired with our operational assessment and executive reporting, we identify provider trends, improve physician order accuracy and responsiveness, and drive utilization management improvement throughout your organization. 

  • Remote, real-time first-level utilization review coverage anytime: overnights, weekends