Revenue Cycle Utilization Management

Revenue utilization review rur is a formal evaluation prospective concurrent or retrospective of medical necessity efficiency or appropriateness of va health care services and treatment plans for an individual patient for the purpose of authorization and reimbursement from third party payers.

Revenue cycle utilization management. The revenue cycle clinical documentation and utilization management departments all should align strategies such as how staff members are communicating with payers during contract negotiations or while mitigating issues related to claims denials. The typical case management department is responsible for utilization management discharge planning and care coordination and these functions all relate to the revenue cycle. These half day in person trainings covered the foundational principles of revenue cycle management rcm and utilization management um. Revenue cycle management rcm includes all administrative and clinical functions that contribute to the capture management and collection of patient service revenue.

Health care leaders have traditionally relied on disparate administrative and clinical functions to optimize the revenue cycle from beginning to end. As revenue cycle management in healthcare continues to advance it is the hospital s obligation to maintain the highest level of patient driven satisfaction by functioning as one unit. The presentation also included strategies and next steps in order to help your organization prepare for the transition to managed care. Open communication can promote less duplication of efforts related to payer interactions.