When managing care, using analytics that predict future outcomes can help hospitals align utilization review decisions with their payers, said Heather Bassett, MD, CMO of Xsolis.
"Not only are analytics important for hospitals when reviewing cases for severity of illness and intensity of service, they can be used as an objective framework for assessing the appropriateness of care," she told Becker's Hospital Review.
"When your relationship with your payer is underpinned by analytics, you have an objective source of truth on the appropriateness of each decision which can remove barriers to reimbursement. Additionally, you can approach utilization management from a 'by exception' model, which creates efficiency for both hospital and insurer."
If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.
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