The Challenge
This hospital faced a breakdown that began in the Emergency Department — silently allowing missed admissions, creating denials, downgraded stays, and lost revenue despite the best efforts of its clinical teams using traditional admission steps.
Early clinical decisions were not consistently aligned with payor requirements, and they were not supported with strong enough medical necessity indicators. Authorizations were not always secured in time. This exposed the hospital to denials, downgraded stays, and lost reimbursement across multiple payor contracts — revenue that was never recovered.
The hospital needed control at the exact moment clinical and financial risk originates: in the Emergency Department, before the patient is admitted, when the right decisions still determine whether a claim gets paid.
The bServed Strategy
bServed executed two concurrent deployments — a full ED Utilization Management program and a parallel Behavioral Health UM deployment — both delivered as plug-and-play solutions with minimal operational burden on existing staff.
Specialized Software
Technology created visibility on ED performance to drive a more efficient and financially stable approach to Utilization Management program in the ED.
Workforce Integration
Clinical and revenue cycle experts function as hospital extensions without disrupting physician workflows or requiring new system training.
Authorizations
Timely payor notification with complete clinical packets and secured authorizations aligned with the patient's clinical presentation.
Revenue Cycle Maximization
Correct level-of-care decisions reducing downgrades, improving claims quality, and ensuring every stay is fully reimbursable.
Medical Expertise
Behavioral health specialists, physician advisors, and review nurses with clinical floor experience guiding high-acuity decisions in real time.
Real-Time Reporting
Leadership visibility into authorization status, level-of-care decisions, and financial performance from ED to discharge.
Hospital-Wide ED-Focused Control
bServed took over real-time review and authorization processes beginning in the Emergency Department, covering all hospital care levels. Physicians maintained unchanged clinical practices. Existing staff avoided new system training. The deployment was immediate and non-disruptive.
- Real-time InterQual and MCG-based admission status determination for Emergency Department patients
- Increases Emergency Department admission rate — 11% to 15% demonstrated, driving approximately $2M+ in additional revenue
- Physician recommendation delivery, 24 hours a day, 7 days a week
- On-site Case Managers are freed to focus on patient throughput and capacity management
Behavioral Health Parallel Deployment
Behavioral Health was deployed simultaneously with hospital-wide UM — a complex undertaking given the unique challenges BH presents:
- Rapid patient status shifts requiring immediate documentation response
- Stricter payor expectations and more detailed documentation requirements
- Greater timing and criteria sensitivity across involuntary and voluntary holds
- Heightened risk of denial when legal status transitions are not captured in real time
- Working closely with the state Department of Mental Health to gather requirements for the inpatient TAR process
- Concurrent authorization management for the Chemical Dependency Unit, ensuring each day is approved by commercial payors while detailed clinical information is provided based on payor requirements
bServed delivered dedicated Behavioral Health utilization management concurrently, implementing real-time oversight, payor-specific documentation packets, and physician advisor involvement for complex scenarios — without delaying the hospital-wide rollout, and driving behavioral-health denials down from 18% to under 1% within 90 days.
Results
"Within the first engagement cycle, this hospital achieved a verified 10X ROI — recovering $3,000,000+ in cash from written-off accounts. The admission rate improved from 11% to 15%, driving approximately $2,000,000+ in additional revenue, while behavioral-health denials dropped from 18% to under 1% within 90 days."
- $3,000,000+ in cash recovered from written-off accounts
- Admission rate improved from 11% to 15% — approximately $2,000,000+ in additional revenue
- Behavioral-health denials dropped from 18% to under 1% within 90 days
- 10X verified ROI across the engagement
- Parallel Behavioral Health UM deployed without disruption to existing clinical workflows
- Zero physician workflow disruption — existing staff required no new training