Broken utilization review (UR) processes can be catastrophic to the revenue cycle. The emergence of artificial intelligence is changing how utilization review gets done, by automating rote tasks and identifying key data to make UR and case management departments work smarter. Understanding how to use UR expertise and technology most effectively can revolutionize revenue integrity and compliance outcomes. ?
In this session, attendees will learn how one health system moved from a challenging UR environment to a high-performing one. The discussion will include an understanding of the pitfalls and solutions to achieve appropriate reimbursement.
• Describe the challenges hospital CFOs and financial leaders face in assessing the health of their utilization review process.
• Explain the challenges that can result in an inefficient utilization review and the related impact on a healthcare organization’s revenue integrity efforts.
• Discuss the different physician advisor deployment models, and how to broaden physician advisor scope to reap the most benefits from this critical resource.