About the Facility
This acute care facility provides 24-hour emergency medical services to its community. The hospital has grown significantly over its history into a large multi-specialty facility, and serves a high-acuity patient population across cardiology, emergency medicine, and a full range of acute specialties.
With expansion came complexity: more payors, more service lines, and a greater volume of admissions requiring concurrent review. The Case Management team was stretched, and the gaps began to show in the numbers.
The Challenge
Before implementing bServed in October 2022, this hospital faced a compounding set of utilization management problems driven primarily by Case Management staffing shortages and inconsistent review quality.
High Payor Denial Rates
Insufficient concurrent review resources meant authorizations were missed and clinical documentation didn't meet payor standards — resulting in widespread denials across service lines.
Case Management Shortages
Staffing gaps left the UM program understaffed and reactive rather than proactive, preventing timely payor communication and continued stay reviews.
Low Medical Necessity Review Quality
Reviews were inconsistent and frequently failed to capture the clinical severity needed to justify inpatient status — leaving legitimate cases vulnerable to downgrade or denial.
Extended Length of Stay
Without systematic discharge planning tied to authorization timelines, patients remained in the hospital beyond medically necessary days — creating both clinical and financial risk.
The bServed Solution
bServed deployed its comprehensive Inpatient Utilization Management Program — functioning as a clinical and administrative extension of the hospital, embedded into existing workflows without disrupting physician practices or requiring staff retraining.
Concurrent reviews began in the Emergency Department, with bServed's clinical team validating medical necessity at the point of admission and submitting complete clinical packets to payors before the window for timely notification closed. Physician advisors engaged within minutes on complex or borderline cases, correcting level-of-care assignments in real time rather than after denial.
Continued stay reviews were tracked daily, with same-day updates to payors as clinical status evolved. Discharge planning was integrated into the UM workflow — identifying transition-ready patients earlier and reducing medically unnecessary hospital days without compromising quality of care.
- Full concurrent review from ED through discharge across all service lines
- Real-time payor notification with payor-specific clinical documentation packets
- Physician advisor integration for complex admissions and borderline criteria
- Daily continued stay reviews with same-day payor communication
- Systematic identification of care continuum gaps driving extended stays
- Appeals and retro review support for any denials received
Results
"The hospital's denials rate dropped by 43%. The facility has been able to identify gaps in the patient care continuum and decreased the average length of stay by 1 day — improving both financial performance and throughput across the hospital."
- 43% reduction in payor denial rate — achieved through real-time review and authorization
- 1-day decrease in average length of stay — driven by systematic care continuum management
- Improved throughput and bed availability across the facility
- Consistent medical necessity documentation quality across all service lines
- Case Management gaps fully absorbed by bServed's embedded clinical team