Taylor Regional Hospital

About the Facility

Taylor Regional Hospital (TRH) is a 90-bed community hospital serving Campbellsville, Kentucky and the surrounding region. Despite its size, TRH offers a broad clinical footprint — from Emergency Department and obstetrics to orthopedics and cancer treatment — making it a critical access point for a population with limited nearby alternatives.

The Challenge

Before engaging bServed, Taylor Regional had no dedicated Emergency Department Utilization Management program. The absence of systematic UM at the point of entry created two compounding problems that were quietly draining the hospital's financial performance.

First, admission rates were low — not because patient acuity didn't warrant inpatient care, but because there was no structured process to validate medical necessity at the moment of ED evaluation, engage physician advisors on borderline cases, or correctly assign patient status before the window for timely payor notification closed.

Second, the hospital was experiencing high payor denial rates driven by documentation gaps, missed authorizations, and delayed communication. Without a concurrent review team actively managing each case from admission through discharge, denials accumulated — and the appeals process wasn't consistently closing the gap.

For a 90-bed rural hospital, the margin for this kind of revenue leakage is thin. Every missed admission and every uncontested denial has outsized financial impact on a facility of TRH's size.

The bServed Solution

bServed implemented its Emergency Department Utilization Management program at Taylor Regional in October 2022 — building a concurrent review process from the ground up without disrupting physician workflows or requiring new infrastructure from the hospital.

The focus was on two simultaneous priorities: increasing justified admissions by validating medical necessity in real time at the ED, and stopping denials by securing authorizations early and maintaining active payor communication through each patient's stay.

• ED-based concurrent review at the point of clinical decision — before admission
• Real-time medical necessity validation against payor-specific criteria
• Physician advisor engagement within minutes on borderline or complex cases
• Payor notification submitted at optimal timing with complete clinical documentation
• Active continued stay reviews — same-day updates when clinical status changed
• Appeals and retro review support to recover any denials that came through
• Full deployment without operational disruption to existing clinical staff

Results

• 30% increase in admission rate — driven by justified clinical decisions at the point of entry
• 40% drop in payor denials — through proactive authorization and documentation
• First-ever ED Utilization Management program successfully deployed at TRH
• Measurable financial improvement for a community hospital with limited margin
• Full program built and operational with zero disruption to clinical workflows