Medical Necessity & Utilization Review (UR)

HCRCM's team of reviewers are experts in screening the hospital admissions for medical necessity through the Milliman/InterQual criteria and assess the quality of care, appropriateness of decision-making, place of service, and length of hospital stay. The KPAI CDI application automates the generation of the inpatient Admission Criteria forms based on either InterQual or Milliman criteria.

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HCRCM's UR process includes:

  • Admission Review
  • Concurrent Review
  • DRG Validation

    • Clinical Documentation Improvement (CDI)

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    HCRCM's CDI program is designed to improve inpatient record documentation and provide an accurate picture of the patient’s acuity, severity of illness, and expected chance of mortality. A systematic process is laid out utilizing a concurrent review team to strengthen communication between physicians and the coding professionals. KPAI CDI is a tool that manages the CDI workflow and automates the query generation process.

  • Improve current CDI efforts
  • Ensure proper documentation and appropriate reimbursement
  • Identify compliance issues and areas of improvement
  • Physician education and training
  • Appropriate dashboards and analytics
  • Maximum reimbursement for resource utilization
  • Increasing Case Mix Index (CMI)

    • Release Of Information (ROI)

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    Patient information may be requested for numerous reasons such as insurance purposes or continuity of care. The medical office has the responsibility to release information in a timely manner upon proper authorization of the patient or their authorized representative. HCRCM strives to make the Release Of Information services most reliable through secure HIM solutions. We offer ROI services to hospitals and health systems.

    ROI services include:

  • Obtaining valid authorization for release of protected health information
  • Completion of the medical record for copying
  • Transmitting of the electronic health record
  • Tracking requests and monitoring the timeliness of the response

    • HCRCM offers:

  • HCRCM ROI application helps you track your entire ROI process
  • Innovative technology solutions for automating and streamlining yourROI
  • Highly trained, knowledgeable and customer service-focused employees
  • Rapid and secure e-delivery methods for instant access to PHI.
  • Quicker turnaround times for patients and requestors