Strengthen Your Financial Sustainability

BHCC scores evidence of medical necessity. This allows UR staff to identify cases needing additional documentation to decrease the risk of denial. This helps the facility increase revenue through a longer length of stay (LOS) as needed, based on symptoms.

BHCC strengthens peer-to-peer reviews. It clearly highlights all the new documentation since the last review. Denial tracking aids communication with providers through call scheduling and an integrated calendar. This provides a shared record of the peer-to-peer calls between providers and UR staff.

BHCC enhances collaboration. Automated alerts and notifications of pending deadlines and missing documentation reduce the need for UR staff to chase down providers.

BHCC strengthens the final appeal process. Continuously updated documents ensure a complete record when submitting the appeal. One hundred percent document completion prevents surprises!

BHCC tracks denials by review call, insurance provider, and diagnostic class. Clinical performance KPIs show peer-to-peer success rates, highlighting strengths and weaknesses for process improvement.

Pre-call assessment: Tightly scheduled insurance review calls often cause UR staff to rush to the review without enough evidence of medical necessity. Automated processes continuously scan the EMR for information. The ranking and scoring model allows UR staff to know in advance which patient cases are strong and which require additional documentation. This ensures sufficient preparation for each call.

During the call: BHCC’s up-to-date patient summaries provide evidence strength and rapid access to supporting documents during the call. UR staff can quickly become familiar with new or new-to-them patients and have the strongest document excerpts on one screen. They can answer questions with direct quotes and easily view document sources. This improves presentation quality and decreases denials.

Post-call review: After a concurrent review call resulting in a denial, the UR staff notes the “denial reason.” This provides insight for process improvement. If a peer-to-peer is indicated, the provider and UR staff receive automatic confirmation of the time and date. You know who’s accountable! The patient summary quickly shows the provider the status with supporting documents and a clear indication of new content since the last call. This allows the peer-to-peer provider to focus on their assessment and new information.