Documentation that doesn't align with payor-specific criteria invites denials that could have been prevented before discharge. bServed's medical necessity review services apply the right criteria to every case during the stay, with documentation structured to withstand payor scrutiny at every level.
What's Included
- Real-time medical necessity validation against InterQual and MCG criteria
- Payor-specific criteria application to support every level-of-care decision
- Criteria-aligned documentation updates throughout the stay
- Physician advisor involvement for all borderline or disputed cases
- Immediate clinical updates when payor requirements are not met
InterQual and MCG Clinical Reviews
InterQual and MCG are among the most widely used commercial criteria sets in clinical review. bServed's reviewers work from them, and from the specific criteria each payor applies, so documentation is written to the standard it will be judged against.
For Medicare Advantage, the rules on which criteria a plan may use are worth knowing. See When Medicare Advantage Denies a Continued Stay, Ask Which Criteria It Used.
Medical Expertise on the Floor
Behavioral health specialists, physician advisors, and review nurses with clinical floor experience guide high-acuity decisions in real time, not retrospectively.
Results
At Hospital 4, bServed replaced inconsistent daily review with a structured medical necessity workflow: the observation rate fell to 30% from 70%, and the inpatient approval rate reached the high 90s.
Related Services
Inpatient Concurrent Review Services
Daily continued stay reviews for all active patients.
Observation vs. Inpatient Status Review
Correct status from admission, every time.
Physician Peer-to-Peer Review Coordination
Physician advisors prepared for disputed cases and denials.
Related reading: When Medicare Advantage Denies a Continued Stay, Ask Which Criteria It Used