Medical necessity

Manage compliance with medical necessity requirements on every patient case.

Medicare and Medicaid reimbursements represent a significant portion of most hospitals’ operating revenues. Over the last several years, there has been a dramatic increase in both the number of CMS auditing agencies and the scope of their audits with the primary focus of rooting out fraud, waste and abuse in our health care system. There also has been a significant increase in Office of Inspector General (OIG) and Department of Justice (DOJ) activity. Medical necessity continues to be a primary target in ongoing audit and investigation activity. 

 

Medicare and Medicaid admission review

Optum™ Executive Health Resources® (EHR) and our specially trained physician advisors help you maintain medical necessity compliance.

Audit management

Manage audit processes while addressing vulnerabilities and protecting revenue.

Optum™ Audit Management provides a single software solution for managing compliance with multiple medical claims audits conducted by government and commercial health care plans.

Medicare and Medicaid appeals management

Successfully manage your appeals process.

Executive Health Resources® (EHR) physician advisors, now a part of Optum™, can help your hospital effectively manage your appeals process.

AccURate™ commercial admission review

Reduce self-denials through appropriate utilization review.

Learn how Optum™ Executive Health Resources® (EHR) physician advisors can help you place a strategic focus on commercial utilization management to reduce self-denials and make a huge impact on your top line.  

Commercial payer denials management

Streamline the denials and appeals process.

Handling denials and appeals can be time consuming and costly. Optum™ Executive Health Resources® (EHR) physician advisors help simplify the process.

Audit and investigation support

Support through the entire audit process.

Federal audit and investigation activity has increased significantly in recent years. Facing a federal audit or investigation can be an intimidating task, but our team of experts can help you feel confident throughout the process.