Centralizing your utilization review functions is a quality improvement measure that helps save a great deal of money, and it can help narrow gaps in coverage because of inter-rater reliability. There are a lot of companies making the transition from unit-based models to more centralized ones when it comes to utilization review functions. With the old triad models, care management staff would be responsible for performing tasks such as discharge planning, utilization review, and case management.
A lot of smart organizations understand the financial implications of having either an inaccurate utilization review or one that is simply non-existent. If your practice can successfully identify the proper patient status, it reduces the number of denials your practice sees, your observation rate will reflect more accurately on what kind of care you offer, the duration of stay gets managed better, and there will be more chances to bring in revenue. By separating the utilization review function, you open yourself up to a range of benefits. Here is why you should think about centralizing your utilization review functions.
Cost Savings
The first thing centralizing utilization review functions can do is save some extra money for you. Clerical staff will be able to help with various administrative activities, including responding to the requests of payers and the planning of payer coverage and assignments. This lowers the staffing requirements your practice will have, and it will reduce the time it takes to get these tasks done.
Cross-Coverage
When they are not unit-based, your utilization review staff will be able to cover many different areas with less trouble. They will be able to cross-cover for one another any time there is an absence or whenever the census is high in a certain spot. You can also redeploy your staff whenever they finish a task if there is any surplus time. This helps your business to be more productive overall and without using any extra resources.
Consistency & Quality
All medical companies will want their staff members to conduct reviews well and perform as well as they possibly can. However, this does not always come to fruition. But, if you centralize your utilization review functions, it will be easier for your management team to communicate what the best processes will be. They can also use training to create inter-rater reliability, and they will be able to track productivity among all of the utilization review staff, and all without having to put in nearly as much effort.
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