Hospitals comparing utilization management companies tend to hear the same promises: 24/7 coverage, expert reviewers, fewer denials. The differences are in the details. This guide lists what to check when you evaluate healthcare utilization management companies, in the order that usually matters. If you're still deciding whether to outsource at all, start with Outsourced Utilization Management: When It Makes Sense.
Seven Questions to Ask Any Vendor
1. When is the team actually working?
Look for 24/7 coverage that includes the Emergency Department, not just a weekday daytime team. Admission and status decisions happen at all hours, and the first review often sets the course of the stay.
2. Who is doing the reviews?
Ask about the people, not just the software: review nurses with clinical floor experience, physician advisors for disputed cases, and behavioral health specialists if you need them. In bServed's model, these experts guide high-acuity decisions in real time, not retrospectively.
3. Which criteria do they apply?
InterQual and MCG are among the most widely used, but each payor applies its own version of the rules. Ask how the team keeps payor-specific criteria current, and how it handles Medicare Advantage plans, where the rules on internal criteria are specific.
4. How does it work with your EMR and your staff?
The best arrangements don't ask your clinicians to learn a new system. bServed integrates with any EMR and aligns with existing hospital workflows, with no major infrastructure changes.
5. How long until it's running?
Ask for a realistic timeline in writing. bServed's implementation is typically complete within 30 days.
6. What will leadership see?
Ask to see a sample report. You want visibility into authorizations, level-of-care decisions, denial rates and financial performance, in real time and not weeks after the fact.
7. What results can they show?
Ask for documented outcomes at hospitals like yours, and what changed in the process to produce them. bServed's five case studies show denial reductions of 40% to 43% across hospitals of different sizes.
Red Flags
- Vague answers about coverage hours, or no coverage in the Emergency Department
- No named physician advisors, or no clear path to one when a case is disputed
- A requirement that your staff adopt new systems
- Reporting that arrives only after discharge or after the claim
- Results that can't be tied to a specific hospital or a specific change in process
Where bServed Fits
bServed delivers hospital utilization management from the Emergency Department through discharge. See the full list of hospital revenue cycle management services, or the most common starting points: emergency department utilization review, inpatient concurrent review, and denial prevention. For the results behind the numbers above, see the Results page.