What is Utilization Management?
Utilization Management assures your patients receive the care they need and provides a base to start focusing on denial prevention. Utilization Management comprises three assessments: prior authorization, pre-bill reviews, and concurrent reviews.
- Prior Authorization: Also known as prospective reviews, prior authorization decreases denials and increases patient access by requiring approval before performing services.
- Concurrent Review: The concurrent review process increases patient access. It also decreases a hospital’s time to revenue by determining coverage during the patient’s stay.
- Pre-bill Review: Also known as retrospective reviews, pre-bill reviews increase clean claim rates by determining coverage after the services are performed.
How Does Utilization Management Benefit My Health System?
Utilization management is a trending topic in healthcare, and for good reason. Utilization management keeps healthcare costs down while maintaining or increasing patient satisfaction. This article series aims to outline how to implement utilization management into your organization; begin to reap the benefits such as decreased cost to collect and decreased burden on your revenue integrity staff.
In this article, learn about best practices and recommendations to optimize your revenue cycle by increasing your clean claim rate. A clean claim rate differentiates denial prevention from denial management. An increased clean claim rate is achievable by tackling key factors with the help of your organization’s front-end staff.
The second article in the series discusses how denial prevention through proactive utilization management can benefit health systems and hospitals. A denial prevention mindset reduces your organization’s time to revenue. It also can decrease clinical staff burnout in an age of increased staff turnover.
The third article introduces the integration of analytics to optimize your revenue cycle and decrease your cost to collect. Leveraging innovative technologies can be daunting, but are a great resource to strengthen your revenue cycle processes.
Our final article discusses the anatomy of a strategic partner and how one can decrease your time to revenue. An estimated 92% of hospital administrators are still struggling to retain administrative and support staff. Outsourcing UM to the right partner can be a step towards financial recovery.
How Advent Can Help
Advent Health Partners’ utilization review process uncovers opportunities to improve organizational management, eliminate oversight, and create systemic approaches to ensure maximum revenue recovery. Advent Health Partners works as part of your team to complete more utilization management reviews, reinforcing your organization’s denial prevention strategy and letting your clinical team do what they do best: patient care.
To discover how Advent Health Partners can increase financial recoveries and operational insights for your hospitals or health system, please connect via the button below.