UTILIZATION ANALYTICS, LLC

We provide a comprehensive suite of services, tailored solutions, broad-based support functions, and targeted strategies to improve and streamline your Case Management and Utilization Review program.

Overview

Here is a quick overview of the suite of services offered by Utilization Analytics. Each service is custom tailored to your program. Additional detailed information is available for each service.
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    Physician Advisory Services
    We can provide real-time 1st & 2nd level physician advisor services to support admission medical necessity, level of care review, and continued stay review. In addition, we can assist with providing medical direction to your Utilization Review and Case Management Department.
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    Education & Training Modules
    UR & CM concepts and processes are not difficult to understand. The biggest issue is that most providers have not had sufficient education regarding the concepts. The other limiting step is embracing the concept, and understanding of the worth of the process.
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    Denial & Appeal Analysis & Management
    A denial for services rendered can be the result of several issues or at any point along the utilization review process. Better understanding of the exact reasons for a denial can result in a targeted approach to correct deficiencies and apply new strategies to minimize or avoid future denials.
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    Clinical Documentation Improvement
    Clinical Documentation Improvement programs play a critical role in the healthcare delivery process. By providing a true representation of patient care they increase compliance, reduce risk, identify quality of care issues, affect quality metrics, and impact revenue cycle. Utilization Analytics can provide comprehensive CDI services.
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    Data Analytics & Population Health
    In the present world of healthcare BIG data, Utilization Review and Case Management have largely been ignored. There is a wealth of clinical information that can be used to drive process improvement, reductions in length of stay (LOS), improve compliance and better understand resource utilization. We apply robust analytic tools to foster a more effective UR and CM program.
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    Clinical Case Reviews/Audits
    An unbiased audit or case review can provide valuable insight and information. Whether it is an individual case or a cohort of cases, Utilization Analytics can provide an external review function that provides an unbiased assessment and report. This report can be used in myriad ways including to change a process, address noncompliance, target educational opportunities or present to hospital leaders.
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    DRG Reassignment Review
    Payers have been increasingly aggressive in reassigning lower DRG codes and subsequent payments. In the past, most DRG reassignments were based on coding issues, however payers have increasingly applied strict clinical documentation parameters to support DRG reductions. We critically review DRG reductions and develop programs to support your coders and clinical staff.
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    Custom Support & Solutions
    Do you have a specific need, problem or question? Utilization Analytics, LLC can provide custom, tailored solutions and unbiased consultation for your Utilization Review or Case Management needs. We will entertain any service request and it is our goal to advocate on behalf of your institution and the patients you serve.
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    Transmittal Code 541 Help
    Medicare auditors have been given guidance and have at their discretion the authority to deny claims related to a patient’s healthcare treatment event. If the inpatient event is denied, related services can also be denied and the physician could be forced into a post-payment recoupment situation. Utilization Analytics can help physicians and hospitals defend denied claims.
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Insurance Precertification Assistance, Guidance & Support
Pre-certification of procedures, inpatient stays, or other insurance transactions are an important part of healthcare delivery system for your patients. Errors or failure at any point can result in a loss in revenue, increased costs to patients and unnecessary exposure to audits and denials. Our staff has extensive experience in commercial, medicare and medicaid insurance pre-certification, documentation and forms processing.
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Who We Are

We are a Utilization Review and Case Management Support

What We Do

We provide comprehensive Utilization Review and Case Management Support Services

Contact Us

Please do not hesitate to contact us

Telephone: (440) 829-7562
Fax: (440) 378-4018
Email: info@utilzationanalytics.com