Concurrent Reviews

Protecting Revenue and Improving Patient Flow

Ensuring Medical Necessity and Revenue Protection

Concurrent review, the process of evaluating medical necessity on a daily basis during a patient’s stay, is one of the most effective tools for both clinical and financial performance. By confirming that each hospital day meets payor criteria, concurrent reviews reduce denials, strengthen reimbursement, assist in LOS management, help to identify avoidable days/delays in progression of care, identify downgrade/upgrade opportunities and keep patients moving through the system appropriately.

The Financial and Operational Impact

The Cost of Correct Level of Care Delays

Because patients change status at any time, and delayed decisions lead to denied days and wasted high-acuity beds. Real-time, 24/7 review protects reimbursement the moment criteria change.

Why Real-Time Level of Care Alerts are Important

1. Correct OBS vs IP placement protects reimbursement.
2. Faster downgrades from ICU or Tele reduce costly, non-reimbursed days.
3. Immediate upgrades prevent missed revenue when patients meet higher-acuity criteria.
4. Improved bed flow increases capacity and speeds admissions.
5. Real-time authorization alignment prevents denied or unpaid days.

Proactive Level of Care Optimization enhances patient flow and timely safe discharges

Concurrent reviews do more than protect reimbursement. They directly support patient flow and bed availability. When patients remain at an inappropriate level of care, it delays discharges and creates bottlenecks in the emergency department.

By identifying patients ready for downgrade or discharge, concurrent reviews help hospitals open beds sooner. This reduces strain on clinical teams, improves care transitions, and strengthens overall hospital efficiency.

The Power of Full Integration

bServed is Full-Service Revenue Cycle, Case Management, Level of Care Optimization and Denial Prevention supported by our proprietary software is continually updated to meet any need our team members discover in your organization.

Real-Time Medical Necessity Reviews into the electronic medical record to ensure real-time documentation.
Real-Time Level of Care Optimization via communication with physicians as the patient condition evolves throughout the stay.
Real-Time Performance Metrics, giving hospital leadership a clear picture from ED to Discharge. Eliminating costly corrections downstream as well as improving physician engagement and documentation.
Real-Time Payor and Physician advisor escalation, resolving disputes before patient discharge (by our PA's or yours).

The Cornerstone of Effective Revenue Cycle & Utilization Management

Concurrent Medical Necessity Reviews that lead to Secured Authorizations are a cornerstone of effective utilization management.

Hospitals that are serious about protecting their revenue invest heavily in structured, daily reviews, not only safeguarding reimbursement but also creating a more efficient and patient-centered care environment.