An effective utilization management program requires visibility into the entire clinical revenue cycle process to address the vulnerabilities that exist due to the thousands of interdepartmental hand-offs, clinical complexity, regulatory changes, payer contractual requirements, and billing/reimbursement rules. While most organizations have invested heavily into managing all aspects of their healthcare revenue cycle, few have adequately addressed the needs of utilization management. This is where Cure Care Technologies can help.

We combine data analytics, clinical, and healthcare expertise to provide hospital utilization management teams with the visibility, tools, and know-how required to improve revenue, eliminate compliance risk, and enhance efficiency.

For years, utilization management has taken a “one-size-fits-all” approach to utilization management, assessing each case with commercial screening criteria and referring cases to a physician advisor for a second review if screening criteria are not met. This process results in complex issues often falling through the cracks and is no longer adequate to meet today’s regulatory intricacies and contractual challenges.

At Cure Care Technologies, we analyze your data and combine it with regulatory, compliance, and managed care expertise to streamline the process and make it more efficient for our clients.

Our team works closely with your utilization management team leveraging internal strength and capabilities while identifying risks and highlighting opportunities for improvement.

Our strategic advisors provide your team with the data and insights to assess utilization management’s impact on the healthcare revenue cycle. The Cure Care Technologies utilization management solution consists of:

Programmatic Approach

The Cure Care Technologies approach combines several interconnected processes and looks at the overarching goals of all of them. The objective is a more effective, efficient utilization management process that supports your organization’s clinical revenue cycle goals. We achieve this through:

• Enhancing internal processes
• Identifying compliance risks and contractual revenue leakage
• Providing solutions to address process vulnerabilities and risks
• Managing denials and appeals
• Providing ongoing education

Data-Driven

We use clear and thorough data to help our clients understand how utilization management impacts the revenue cycle. We monitor processes, regulations changes, and payer performance. Analyzing performance data helps us evaluate:

• Accuracy of patient status
• Payer responses and denial behavior
• Internal methods for managing denials and obtaining payment

Data analysis guides processes and ensures we fix errors while allowing us for fully-informed and compliant decision-making by hospitals.

Flexible

The Cure Care Technologies solution is tailored to each organization’s needs and capabilities, leveraging a hospital’s utilization management resources and investments.

Regulatory Compliance

Staying current on regulatory issues and compliance is an essential requirement for utilization management teams. The Centers for Medicare and Medicaid Services’ (CMS) requirements and guidance, such as the 2-midnight rule, must guide hospital staff in creating utilization management processes and ensuring appropriate patient statusing.

At Cure Care Technologies, we help our clients to navigate this Rule by providing physician advisor status reviews, monitoring compliance with the Rule, performing compliance audits, and educating attending physicians on the requirements of the Two-Midnight Rule. At a time when hospitals are struggling to hire and retain staff, the Cure Care Technologies approach to the Two-Midnight Rule results in the effective use of staff time.

We constantly monitor the ever-changing regulations to ensure our hospital clients are maintaining compliant processes. By providing our clients with education and training as needed, we help to ensure that our clients have the information they need regarding any regulatory updates.

Revenue Integrity

Improving revenue integrity is the objective. Cure Care Technologies program includes :

• Patient status review and process redesign (if needed)
• Performance trending, audit, and monitoring to address issues and opportunities
• Physician monitoring
• Education and training for utilization management and other departments
• Payer denial review and analysis
• Payer contractual requirements for utilization management
• Documentation review
• Billing cycle review
• Identifying opportunities for improvement

If your utilization management is looking to go from good to great, you can count on Cure Care Technologies. Contact us today to book a strategy call.