Detailed Medical Necessity Review
It’s impossible to deliver quality health care without solid case management.
Treating patients is easier with skilled coders at your side.
The Importance of Medical Necessity in Medical Coding
Facilities that don’t support medical necessity with evidence-based clinical reviews, coding procedures, and proper documentation struggle with claim denials. Treatments for illness or injury can only be considered medically necessary after submitting the relevant diagnosis codes to the health insurance provider.
Without specialists who understand the medical code’s nuances and what insurance companies consider medically necessary, securing reimbursement for patient care can be challenging.
Horizon Healthcare has the experience and resources to enhance your necessity review process. Not all diagnoses for procedures are considered medically necessary—our professionals have deep knowledge of the coverage policies for programs like Medicare and Medicaid. They can ensure your organization meets all documentation requirements and adheres to all coverage policies. We make reimbursement a straightforward and reliable process to reinforce your revenue cycle management strategy.
Qualified Assistance Anywhere in the Nation
Horizon Healthcare RCM is a fully remote workforce, allowing us to efficiently employ experienced and well-qualified team members throughout the country. We promote employee retention through our flexible work-life balance. No matter where you need us, we’re ready to help.
Detail-Oriented Necessity Case Management
As a medical practice, you prioritize supporting patients with outstanding health care services. It’s a full-time commitment, and when you’re focused on helping people, it’s natural for the finer details to get lost in the shuffle.
Horizon Healthcare RCM helps you stay organized and well-funded with our medical necessity review services. We have extensive knowledge of coverage policies that we apply to help you stay proactive in avoiding claims denials and preventing revenue stream shrinkage. With our resources, you can educate your health care providers and patients on what documentation is needed to support certain services and elevate the patient experience to new heights.
Our team of coders and billers help you:
- Improve the quality and consistency of your medical necessity review process
- Achieve high quality in first-level admission reviews
- Reduce claim denials from health insurance providers due to inadequate documentation
- Meet clinical criteria quickly and efficiently
We’re a Natural Extension of Your In-House Personnel
Medical necessity review is simple with a full-fledged team of medical billing and coding experts in your corner. Since 2005, we’ve supported organizations nationwide with advanced technology and solid partnerships. When you partner with us, we share your values and goals, working closely with you to create a collaborative, productive, and rewarding environment.
We help you achieve optimal revenue generation by maintaining detailed medical records and helping you navigate patient health plans throughout the utilization review process. If you’ve struggled to find the time and resources to meet the accepted standard for medical necessity review while offering excellent patient care, we’re here to lend a hand and help keep your cash flow in top shape.
50+
Healthcare Facilities Supported
100+
Accounts Receivables Resolved
We Provide Comprehensive Utilization Review
Informed care is excellent care. Proper utilization review allows medical professionals to assess a patient’s needs accurately and prescribe the most effective treatment. The Horizon Healthcare RCM team uses evidence-based criteria to evaluate patients’ clinical pictures and determine the most relevant care setting for their needs. We ensure that from the first-level review, you have the information you need to review medical necessity, level of care, and progression of care entirely and efficiently.
Careful Prospective, Concurrent, and Retrospective Evaluation
Horizon Healthcare RCM’s utilization review services determine whether your subscribed patient care is justifiable and reimbursable. We discover appropriate levels of care and ensure patients advance through your medical system without delays. Nurses and doctors with a fully established utilization review process can more accurately document medical necessity reviews and address patient concerns with the confidence reimbursement will be straightforward.
