Concurrent Review
Our concurrent review methodology deploys a structured, proactive model designed to prevent technical denials through real-time patient evaluation and workflow optimization. By integrating 18-hour milestone evaluations, objective documentation strategies, and evidence-based clinical criteria into the daily care cycle, we partner with our clients to ensure medical necessity is continuously captured and justified. This continuous alignment of clinical operations with compliance standards secures accurate status determinations from admission through discharge.
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How We Support Our Clients
Our approach relies on a comprehensive, multi-step process integrated directly into hospital workflows.
We train and equip key process stakeholders with the protocols to execute timely observation-to-inpatient status conversions, integrating payor notification procedures directly into the workflow to prevent delays.
We implement automated alerts at the 18-hour observation threshold to trigger structured status reviews, ensuring timely level-of-care reassessment and compliance with payor notification timeframes.
Discharge planning protocols are initiated right at the point of admission to ensure transition-of-care documentation strictly aligns with the expected length of stay and the Two-Midnight benchmark. MHMDAA reinforces and supports the onsite physician’s clinical decision-making process.
We rigorously integrate vital signs, imaging, and lab results to continuously document clinical acuity and progression, constantly evaluating objective data against InterQual, Milliman (MCG) guidelines, and CMS admission standards.
Concurrent Review
A structured concurrent review model featuring proactive status conversion training, 18-hour milestone evaluations, transitions of care planning support, and objective documentation strategies designed to prevent technical denials.
Our team equips and trains clinical staff to execute timely conversion from Observation to Inpatient status conversions, reducing technical denials that arise from status conversion delays.
Implementation of earlier structured 18-hour status reviews ensure timely level-of-care reassessment and compliance with Payor notification requirements. This milestone-driven approach supports accurate status determination and defensible documentation.
Discharge planning is initiated at the point of admission to ensure transition of care documentation aligns with the Two-Midnight benchmark. This proactive approach supports accurate status justification and reduces length-of-stay–related denials.
Integrate vital signs, imaging, and laboratory results throughout the patient’s stay to justify continued inpatient necessity.
Utilize evidence-based criteria to justify inpatient status determination, ensuring medical decision-making is supported by current clinical guidelines.
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