AccURate commercial admission review

Reduce self-denials through appropriate utilization review.

Learn how Optum™ Executive Health Resources® (EHR) physician advisors can help you place a strategic focus on commercial utilization management to reduce self-denials and make a huge impact on your top line.  

As hospitals have increased focus on utilization management for Medicare fee-for-service patients, it’s left little time to focus on commercial utilization management activity, resulting in an increased use of observation, incorrect status determinations and an increase in self-denials. Unlike the Medicare regulatory guidelines, managed care contracts are unique to hospitals and managed care companies alike. Simply working toward reducing self-denials through appropriate utilization review can have a huge impact on a hospital’s top line without growing volume, changing payer mix or renegotiating payer contracts.

EHR physician advisors can help your hospital ensure a consistent utilization review approach to your commercial payer patient population and help decrease instances of self-denial. Through an expert AccURate™ opportunity analysis, our team will help you identify the payers that offer you the greatest opportunity to help prioritize your focus area.

EHR’s AccURate offering helps your hospital identify opportunities for improvement through comprehensive data analytics including:

  • Targeting payers where IP and OBS differential is substantial and OBS rates are high
  • Eliminating self-denials/downgrades through consistent and accurate review processes
  • Maintaining a consistent process with governmental payer reviews
  • Validating accuracy and progress through quarterly analytics review

Changing health care rules and regulations focused on medical necessity are a continual source of confusion for hospitals and other health care providers. To stay on top of the latest news and strategies regarding medical necessity compliance and appeals management, EHR has created The Compliance Library.