Utilization Review

HFRI's Utilization review service is designed to improve cash flow through the recovery of medical and procedural denials and to improve hospital internal processes through effective consulting services. Our involvement can resolve issues as basic as referral and authorization denials to more complex denials involving reduced days of coverage, medical necessity, non-emergent care and pre-existing conditions. Referring these matters to HFRI enables Case Management and Utilization review to focus their efforts toward concurrent issues related to patient utilization and discharge planning, ultimately reducing future denied claims.

In addition to our ability to resolve these claims, HFRI can provide support and assistance to both the patient accounts and utilization review departments through individual case updates and training from a clinical and practical billing perspective.