The Emergency Department is where clinical and financial risk originates. bServed positions its multidisciplinary team at the point of entry, validating medical necessity, assigning correct admission status, and working closely with ED providers.
Coverage runs around the clock, from first patient contact through the decision to admit, so the review happens while the patient is still in the department rather than after the claim is filed. bServed's ED program runs with 98%+ authorization success.
What's Included
- 24/7 concurrent review from first patient contact
- Real-time medical necessity validation against InterQual and MCG criteria
- Correct admission status assigned at the point of entry
- Direct communication with ED providers
Real-Time Utilization Management
Real-time utilization management means the review happens while care is being delivered. bServed's specialized software integrates with any EMR to surface utilization signals, track authorization status, and drive timely action, while trained clinical reviewers handle the medical necessity decisions as they happen.
Why the ED Sets the Tone for the Whole Stay
Admission status and the first set of documentation shape every review that follows. A case placed in the wrong status, or admitted without documentation that matches the payor's criteria, carries that exposure through the rest of the stay. Getting it right at entry is the earliest point at which a denial can be prevented.
See Observation vs. Inpatient Status Review for how status is decided, and Hospital Authorization Management for what happens next.
Results
Hospital 3, a rural hospital, started an Emergency Department utilization program from a standing start: admission rate up 30% and payor denials down 40%.
Hospital 1 ran ED utilization management alongside a behavioral health deployment, with $3M+ in cash recovered and a 10X verified ROI.
Related Services
Post Stabilization Review
Protecting revenue after acute stabilization.
Observation vs. Inpatient Status Review
Correct status from admission, every time.
Hospital Authorization Management
Proactive payor notification before the window closes.
Related reading: What Is Hospital Utilization Management? · Outsourced Utilization Management: When It Makes Sense for a Hospital · How to Choose a Utilization Management Company