Hospital inpatient denials solutions and strategy
Building a denials program Re-opening appeals State fair hearings/ALJ
If it's necessary, it can be overturned.
Build a robust inpatient denials management program
Protect Your Revenue
Learn how building a robust in-house physician advising program can have a significant return on investment by switching from a vendor. We'll help you navigate those tricky first few steps and develop confidence in issuing your own secondary reviews, performing peer-to-peers and writing appeals.
In-house advising is an ideal setup for a moderate-sized and above hospital/system. Some smaller places can still benefit from partial implementation, and larger ones can graduate slowly towards vendor independence. Let us help you accomplish this!
Learn How to Use Regulations to your Advantage
Denials come from a diverse array of confusing payors using their own sets of rules, and you need to know those rules to defend your moat--especially if those rules violate laws! These rules can be national (ERISA commercial or Medicare Advantage) or at the state level (Medicaid, fully-insured commercial). Know what regulations govern what payor types to know HOW to fight.
What makes this even more confusing is federal laws that govern state entities (i.e., Medicaid) can be subject to further rules from the state! Let us help you navigate these issues to decide what denials to fight, and how.
Bounty hunting service
Don't Let High Dollar Cases Escape
Some hospitals or systems already have an in-house advising service (great!). Or, they're happy with their vendor services.
In either scenario, sometimes high dollar cases get away from you. Even if you lost the appeal, don't lose hope. It may be possible to use fairly complicated mechanics to re-open the case and get the authorization denial overturned.
Let us work as your "bounty hunter" to recover that revenue for you, entirely on contingency with no investment on your part.