More and more providers are generally tired of the unknowns of the claim denials. Implementing effective claims denial management will help lower the burn on your healthcare organization’s staff and cash flow. But how do you add additional staff to ultimately handle the management of the relevance, medical necessity, and efficiency of healthcare services provided to a patient? When you consider salary + 30% average benefits package on your barely leveled balance sheet, the odds are against you that your manager will agree to an additional team member. Not to mention the fact if your organization might be heading to off-season with lower admission rates.

Lori Intravichit, CEO of Sunlit Cove Healthcare said:

With the value-based models on the rise, hospitals and healthcare organizations must incorporate utilization review in their revenue cycle to prevent unnecessary costs and claim denials. Prior authorizations and medical necessity review will help you stay ahead of the game.

According to AAFP, physician practices see between five and ten percent of claims continue to be rejected each year

Payer’s advanced AI technology and the algorithms that are constantly looking for the slightest omission are more and more efficient at rejecting the claims. Not to mention the never-ending changes in the process of submitting claims. It can be pretty challenging for an inexperienced team to submit an accurate claim on the first try.

While accurate data is one of the aspects of the equation, a good utilization review also goes a step above. It looks at the overall revenue cycle management and optimizes existing processes, tools, and technology that, in return, ultimately lowers denial rates.

We believe that most denied claims are preventable; with correctly outsourcing your utilization review process, you should see a decent ROI on that investment.

Sunlit Cove Healthcare Consultants provides utilization management directors and nurse reviewers who have extensive knowledge and experience in:

• obtaining medical necessity authorizations for payment approval

• responding and adapting to changing market forces and regulations

• ensuring continuity of care and accurate payment for that care.

Conclusion:
We provide these services on as needed basis for a reasonable rate. No need to hire staff as volumes shift with the constant changing environment. Contact us or give us a call at (727) 278-3009 to get started.

Free Process Review Services

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

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