The Utilization Review (UR) function in the emergency department (ED) serves as a critical component to ensure whether a patient is placed as inpatient or observation. Establishing the UR team to manage patient status at the point of admission is imperative to minimizing denials down the line. Too often, hospitals waste time and money by overlooking [...]
By implementing improved processes, physician and staff education, tailored operations strategies and increased admission reviews, this engagement slashed observation rates by a third. As a result of working with utilization review staff to achieve correct patient status assignments, the health system experienced a $1.8M revenue improvement in the first three months of the engagement.
Centralizing Utilization Review Functions is a cost-saving quality improvement measure, closes gap in coverage due to inter-rater reliability. Many forward-thinking organizations recognize the negative financial impact of inaccurate or non-existent UR. Learn how it's worked for a large, newly formed health system...
Based on BFCC-QIO inpatient short stay reviews, Providers could be susceptible to 25 or 10 case request based on audit area and prior audit findings.
The hospital system had been unable to adequately staff their emergency department with utilization review care managers. The hospital system engaged McBee Care Managers to provide coverage on weekends and expand their coverage until 11 p.m. during the week.
This 1,000 bed urban hospital was consistently denied an average of $1 million per month from third-party payers, mostly for one-day inpatient stays through the ED for which documentation reflected observation level of care.