Critical access hospitals face unique challenges that many other hospitals may not face. That makes critical access hospital management a unique and complex process.
With fewer staff members and greater revenue sensitivity, hospital utilization management teams (or the staff member covering UM) at critical access hospitals simply have too much to do. These professionals often do not have time to fight denials, wade through EMR records, or create in-depth reports.
Traditional utilization management tools are not tailored to help critical access hospitals with many of these key issues. Fortunately, CORTEX® approaches UM from a different perspective, emphasizing critical access management in healthcare.
With this strategy, it becomes that much more realistic to tailor utilization review planning and execution to the unique needs of critical access hospitals.
Revenue IntegrityThe right approach to utilization management directly impacts revenue. It means getting cases into the correct status as quickly as possible, expediting the review process, and minimizing denied claims and revenue-at-risk. CORTEX helps hospitals get the correct status for patients up front, reducing uncertainties and mitigating denials before they happen. Gathering all of the vital information needed to get the case approved by the payer partner on the first pass leads to less stress and more efficient operations. |
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Robust ReportingCORTEX has advanced reporting capabilities, giving nurses and executives immediate insight into valuable data. With access to the information and context needed to identify issues and correct them, critical access hospitals can continually improve. With CORTEX in place, it’s easy to review key trends such as observation rate, conversion rate, and missed inpatient-conversion opportunities. Ad hoc reporting within CORTEX gives your team the ability to track discharge readiness and missed conversion opportunities on a case-by-case basis. That can lead to significant quality improvement over time. |
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Payer CommunicationCORTEX acts as the single source of truth on medical necessity for each case in the utilization review process. CORTEX gives both payers and providers access to real-time data to quickly and accurately make decisions based on the case's clinical-merit-aligned analytics and insight. That makes CORTEX a foundational element of a critical access hospital’s utilization review planning and strategy. |
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Reduce Administrative BurdenCORTEX’S machine learning and predictive analytics equips teams with actionable insights for a simplified, more informed utilization management process. That advantage is valuable for every hospital and health system, but especially important for critical access healthcare facilities. CORTEX uses artificial intelligence to reduce manual processes for small multitasking teams with limited capacity to complete case reviews, manage denials, and payer communication. XSOLIS’ Analytics analyzes disparate clinical data from electronic medical records so that nurses don’t have to. |
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Franklin, TN 37067
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