Comprehensive review of inpatient and observation cases using MCG® and InterQual® to identify status discrepancies, documentation gaps, and denial risk.
Denial Prevention & Revenue Protection Support
Proactive case review and workflow improvements to strengthen payer defensibility and reduce avoidable denials.
Observation Management Optimization
Evaluation of observation utilization, extended stays, and appropriate inpatient conversions based on medical necessity criteria.
CMS Compliance Education & Process Improvement
Education and workflow development for MOON/IMM compliance, physician documentation, and consistent application of medical necessity criteria.
Interim or Supplemental Case Management Coverage
Short-term leadership or frontline UR/CM support during vacancies, growth periods, surveys, or increased census.