Balancing high-quality care for your patients while still operating your organization with proper efficiency and economic oversight can be a difficult task for many. In the racetrack that the healthcare industry has become, hospitals and other healthcare practices must stay nimble to ensure that quality care and financial stability remain hand-in-hand. Utilization management in healthcare services can be crucial, given frequent changes in regulations and various reimbursement rules. The utilization review process can be tricky and difficult to manage – which is why health facilities all over the nation are turning to UR nurses to ease the burden on their staff.
At RevWerx, we understand how frustrating the utilization review process can be. Our expertly-trained team will sit down with you to examine your current systems and procedures, and we can recommend solutions to any problems you may be facing in your RCM healthcare cycle. If your organization or facility is having trouble with utilization reviews, we have the experience to help. If a simpler approach to your RCM process would help your practice thrive, contact us today to see what we can do for you. Visit RevWerx online and complete our secure form, or call us today at 833.309.0138.
How a UR Nurse Can Help You
Put simply; utilization reviews are investigations and examinations into the healthcare treatments and services performed by a facility’s doctors and nurses. These reviews ensure an organization isn’t billing insurance companies for unnecessary procedures and treatment, which wastes money. A hospital UR nurse will communicate with the insurance company’s UR nurse about the medical necessity of treatment being performed in the facility. If disagreements arise, the UR nurses will take graduated steps from peer-to-peer conferences down the line to an appeal with the insurance company to reach an agreement.
Proper utilization management is crucial to the financial health and stability of your organization. A UR nurse is usually versed in protocols that clearly define what makes care high-quality and how to best provide that care, from who administers it to where it should take place. One common example is whether or not a client should be admitted to an inpatient stay. When someone is receiving care in your practice, you must know they are being treated to the very best of your ability and resources. Having a UR nurse at your side can alleviate that worry by making sure that they are.
Improving Your Utilization Review Process
Learning what practices are best in conducting utilization reviews is the difference between a successful organization and a struggling one. It’s important to define your processes clearly. Each and every member of your staff should know exactly what is expected of them, and you should keep documentation of your procedures for intake, admissions, professional services, and care setting reviews. It can also be extremely helpful to run concurrent utilization reviews for all of your cases. This will enable you to appeal rejections with ease and hang onto proof of the medical necessity for future situations in which you may need it.
Choose RevWerx for the Advantage of a UR Nurse on Staff
RevWerx has distinguished itself from our competitors by employing a UR nurse on staff. When you work with us, our UR nurse becomes your first lieutenant when communicating with insurance companies, which can be one of the more difficult aspects of the billing cycle. Our staff is an asset to yours, and that makes RevWerx a leader in the healthcare RCM industry. If you’re interested in allying yourself with a team that will create a bespoke plan for your organization and see it through to the end, contact us today by calling 833.309.0138.