Case Management Services
Case Management and Denial Services –
Case Management reviews are provided by our consultant specialist to assist physicians with the medical necessity criteria for observation and inpatient services. We also assist providers with the rebuttal process of carrier denials as well as RAC and MAC audits.
Our Nurse Auditors provide medical necessity reviews for ER physicians to ensure the patient meets the inpatient or outpatient medical necessity criterion as required by CMS. We educate the physicians on the criterion elements to better equipment them as changes occur.