Simplifying Complex Authorizations, Reducing Denials
Utilization
Management Services
Ensure the appropriate and efficient use of medical services, procedures, and facilities.
Overview
Our Utilization Management (UM) services support healthcare organizations in delivering appropriate, efficient, and cost-effective patient care. We evaluate the medical necessity and efficiency of services and procedures through prospective, concurrent, and retrospective reviews.
This comprehensive approach ensures that patient care aligns with current medical standards while promoting optimal resource allocation.
Using evidence-based guidelines such as MCG and InterQual, we confirm that each case meets established clinical criteria and determine the appropriate length of stay.
We maintain clear, effective communication with payers and internal teams, helping to identify and mitigate risks such as overutilization.
This comprehensive approach ensures that patient care aligns with current medical standards while promoting optimal resource allocation.
Using evidence-based guidelines such as MCG and InterQual, we confirm that each case meets established clinical criteria and determine the appropriate length of stay.
We maintain clear, effective communication with payers and internal teams, helping to identify and mitigate risks such as overutilization.
Our team also conducts thorough analyses of medical necessity denials, collaborates with your clinical documentation and denial management teams, and addresses root causes to prevent future issues.
By ensuring the appropriate level of care, avoiding unnecessary procedures, and optimizing treatment plans, our UM services help control healthcare costs.
Through these integrated efforts, we improve patient outcomes, streamline resource utilization, uphold clinical quality standards, and drive excellence in healthcare delivery.
Services Provided
Efficiently manage resources, maintain high-quality patient care, and navigate complex regulatory and payer requirements with our Utilization Management services. Our offerings include:
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Concurrent and retrospective utilization reviews to ensure care aligns with medical necessity and payer guidelines.
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Inpatient authorization extensions for continued stays to reduce net revenue leakage and support appropriate reimbursement.
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Comprehensive chart reviews to validate the medical necessity of procedures in accordance with payer contracts.
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Recommendations for alternative care options when clinically appropriate, helping optimize care delivery and resource utilization.
Benefits
Increased Cost Efficiency
By leveraging evidence-based guidelines, our Utilization Management services promote the appropriate use of medical services, procedures, and facilities.
This approach helps hospitals optimize resource utilization, reduce unnecessary spending, and improve financial performance without compromising patient care.
This approach helps hospitals optimize resource utilization, reduce unnecessary spending, and improve financial performance without compromising patient care.
Enhanced Patient Care
We collaborate closely with physicians to ensure complete and accurate clinical documentation, supporting the delivery of medically necessary care.
Our team also helps navigate complex Medicare and Medicaid participation requirements, ensuring patients receive appropriate, timely, and compliant care aligned with regulatory standards.
Our team also helps navigate complex Medicare and Medicaid participation requirements, ensuring patients receive appropriate, timely, and compliant care aligned with regulatory standards.
Improved Regulatory Compliance
Our Utilization Management services help prevent revenue losses tied to high readmission rates and regulatory penalties. By reducing the risk of denials and audits, we support hospitals in maintaining compliance, improving operational efficiency, and safeguarding financial stability.
Efficiency, Precision, and Performance with RCM
Clinical Administrative
Services
Outsourced clinical resources to ensure compliance, optimize reimbursement, and enhance patient care.
Clinical Prior Authorization Services
We assist in securing clinical authorizations for complex medical cases, including both prior (prospective) and concurrent authorizations, to ensure appropriate reimbursement and timely care delivery in alignment with payer contracts.
Clinical Integrity Services
Accurate coding depends on meaningful documentation that is complete, precise, and consistent. Implementing a well-designed Clinical Documentation Integrity (CDI) program can help you achieve these standards and enhance revenue outcomes for your organization.
Clinical Denials and Appeals
Healthcare providers face significant challenges managing clinical denials and appeals, which can affect timely and full payment for services rendered. Denials often stem from issues related to medical necessity, clinical validation, length of stay, or level of care, and may occur concurrently (while the patient is still admitted) or retrospectively (after discharge).
Physician Advisory Services
We also facilitate peer-to-peer reviews with insurance companies, enabling direct dialogue between our physicians and insurers’ medical professionals. This collaborative approach fosters transparency, improves communication, and builds mutual understanding of complex cases.
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Headquarters
A2O Healthcare
USA Office
10301, Northwest - FWY, STE, 314, Houston, Texas- 77092, USA
Our Locations
Where to find Us?
Delhi Office: 2New Delhi E-92, 1st Floor, South Extension Part-1, New Delhi – 110049, India
Bangalore Office:No 6 4 th Floor Wisdom Heights Kalyan Nagar Bangalore -560043
Singapore Office:1 N Bridge Rd, #46 High Street Centre, Singapore 179094