Client Testimonial: Uniontown Hospital
Maximizing peer-to-peer reviews with an on-site physician advisor
Uniontown Hospital Video Script
Advancing the revenue cycle towards a denial-free future
Optum Physician Advisor Solutions
[Video Title] Maximizing peer-to-peer reviews with an Onsite Physician Advisor
Speaker Identification Overlay:
Supervisor of Case Management
Speaker Identification Overlay:
Director of Case Management
Janet: Prior to onsite physician advisor coming to our facility, we struggled with utilization review process in regard to peer-to-peer denials
Bonnie: The doctors didn’t want to do peer-to-peers because they felt like they were being treated mean. I think the intimidation factor of the insurance companies kept them from doing the peer-to-peers because they just wouldn't do them.
Janet: They didn't know how to talk to the insurance companies or what was being expected of them. We relied on nurse case managers to pretty much give them the information that they needed to do an appeal, it wasn't enough information and we were losing a good percentage of our appeals.
Shifting to an Optum Onsite Physician Advisor
Janet: She's in the building five days a week, Monday through Friday, and then we also have the remote support for evenings, weekends, and holidays, so that our cases are reviewed rapidly, and the turnaround time is excellent.
Janet: She can actually get into the patient's record and from looking at their documentation. It also helps her to fight on the peer-to-peer or the back-end side of it too.
Improving Query Response Rates and Appeal Turnovers
Bonnie: Our physician advisor has embraced our hospital, she understands where we're coming from, the clientele we take care of, also the challenges we have with some of our doctors.
Janet: Our response rate to her requests has increased to 95%. That shows to me that they respect her decisions.
Janet: The main positive result that I can speak to, prior to our onsite physician advisor, we were only winning about 33% of our appeals. Since we've brought on the onsite physician advisor, we are up to 54%, which I think is an astronomical change and the value on return on investment is great.
Optum: a true strategic partner
Janet: Optum has been great at providing service to our facility and customizing it to us. There's never been anything that I've asked of them to do that we weren't able to come to some sort of a process that worked for us.
Bonnie: If someone came to me and asked me, should they go with Optum to help with their peer-to-peers, their denials appeals, or just making determinations, I would say yes, they should go with them. As a nurse, you have your gut feeling, but they have the legal and the medical background to make that decision and be there to stand behind you.
Peer-to-peer reviews with payer medical directors were a challenge for Uniontown Hospital. Physicians felt intimidated during these conversations, and were unable to overturn these concurrent denials.
Listen to how Uniontown Hospital was able to leverage the Optum® On-Site Physician Advisor program to dramatically improve their peer-to-peer success rate.