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Concurrent Medical Necessity Reviews

Featuring Real-Time Physician Advisory Services

Case Management Consultants (CMC), provides 24/7 real-time physician advisory and case management services to hospital and health care systems and practices.
CMC concurrent medical necessity reviews are specifically designed to   assist hospitals in determining accurate patient admission status from initial review to claims payment, and ensure compliance with CMS and other third party payors rules and regulations.

CMC team of specialty trained  Physician Advisors are experienced in the application of  CMS rules and regulations to observation and inpatient status and provide the required secondary, concurrent physician review of observation status cases and inpatient admissions that do not meet case management’s medical necessity screening criteria.

The CMC admission review process utilizes evidence-based medicine and CMS guidance in order to ensure appropriate admission/ observation status certification, chart documentation resulting in the highest level of compliance with CMS rules, and enhanced revenue integrity.

CMC Physician Advisors use proprietary software, evidence-based care guidelines, and algorithms in determining the appropriate admission / observation status resulting in a Physician Advisor second-level review supported by clinical evidence, and compliant with CMS rules and regulations.

CMC’s concurrent admission review and certification ensures compliance with CMS claim status certification rules and regulations. CMC’s Physician Advisor reviews provide evidence-based claim status certification compliant with CMS rules and regulation, and federal law. CMC claim status certifications are robust enough to withstand independent third party scrutiny.

Services provided by CMC real-time Physician Advisors include:

  • Preadmissions Review
  • Admission Review
  • Continued Stay Review
  • Secondary Medical Review
  • Surgery and Procedures Setting Review
  • Concurrent Inpatient Reimbursement Denials Appeal

CMC development teams are available to assist client hospitals and health systems in utilizing CMC’s 24/7 real-time physician advisor services without any infrastructure requirements. CMC concurrent medical necessity review solutions are designed, and customized to work seamlessly with clients hospitals admission and utilization review processes.

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