Continuously compare inpatient stays against medical-necessity criteria and flag cases likely to be denied, days before discharge instead of after the fact.
Case managers manually pull labs, notes, and vitals to build the case for continued stay every day for every inpatient, and by the time a denial risk surfaces the patient may already be near discharge.
labs, notes, and vitals against medical-necessity criteria
Sign off
Day 4 of an inpatient pneumonia admission is showing denial risk. Vitals and labs have trended toward discharge-readiness for the last 36 hours, but the level of care billed is still acute inpatient.
Try it — same review surface your operators use, with a representative decision. Nothing here is saved or sent anywhere.
The judgment on whether a patient's condition and trajectory matches the level of care being billed stays with your case managers and physician advisors.
See this workflow against your own queue.
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