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Clinical Documentation for Highest Level of Reimbursement

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Mission Statement


UR/DC/ Case Management

The "Maximize Reimbursement" Program

The "Maximize Reimbursement" program of Ezra Healthcare, Inc. is an entirely different service and approach from the usual utilization review, discharge planning and case management Services.
Essentially, utilization review services are limited to compiling the documentation that has been generated by the various professional disciplines (Doctors, Nurses, Therapists, Lab Technicians, etc.) for the various services that they provide to a given patient, and then summarizing the information for submission for reimbursement by the insurers. However, the success of utilization review services, and its success for reimbursement, is entirely dependent upon how the documentation has been written by the attendant professionals, as utilization review cannot re-write the documentation. The benefit of utilization review is thus limited – it can only play the cards it is dealt.

Ezra Healthcare, Inc.'s "Maximize Reimbursement" program gives you control over the entire deck of cards. The "Maximize Reimbursement" program addresses how the content of the documentation being generated by the various professional disciplines for their respective services is written, so that the "medical necessity" of each service is clearly demonstrated seamlessly, from a patient's initial admission through every extension of stay and discharge. The insurance company's medical reviewer, in analyzing the documentation for medical necessity, and thereby determining the level of reimbursement, has no opportunity to see the patient and depends entirely upon the submitted documentation. Therefore, the content of that documentation is the actual, critical, determining factor for maximizing reimbursement, and minimizing denials, as well as avoiding the delay of having to go through the process of costly, time-consuming appeals in order to obtain reimbursement.

Ezra Healthcare, Inc.'s "Maximizing Reimbursement" program educates each of the involved professional disciplines on how to effectively communicate the "medical necessity" of their respective services within the documentation of their respective services. Communicating that "medical necessity" to the insurers' medical reviewers justifies immediate and full reimbursement, while also satisfying the cost-containment considerations of the medical reviewers, as well as the applicable federal and state regulatory requirements, in particular Title 22. It is the skillful use of effective technical wording and terminology in the generation of the documentation of services which determines the reimbursement outcome, and that can translate into a more positive bottom-line profitability.

Ezra Healthcare, Inc. looks forward to being of service to you, and offers beneficial consulting skills with regard to both acute and geriatric care with over twenty years of experience in navigating the utilization review decision–making and appeals process.

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         Ezra Health care Inc. All rights Reserved.