Product Strategy

All our products have a single overriding goal, to help our clients develop strong medical management processes that increase profitability and earnings. Our service enable our clients to provide cost effective high quality care to their patient populations, while efficiently interfacing with insurers and other payers.

Physician Advisor Services

CMC provides physician advisor services to our hospital clients to help them quickly identify potential denials and stop them before they occur. We leverage our strong working relationship with health insurance companies as well as intimate knowledge of the insurance regulatory environment to aggressively interface with insurance medical directors to overturn denials. Our service offering is flexible allowing you to use as much or as little of the service as you want.

Denials Management Audits

CMC denial management audits allow you to take an in-depth and detailed look at your denials management effectiveness. How strong is your current process? Where are your areas of opportunity? In addition, our audits go beyond providing information on your denial management effectiveness. We work with you to design a customized solution that, when implemented, will significantly reduce denials on the front end and also improve your appeals recovery rate. Our deliverable to you, the information and knowledge you need to significantly minimize your denials and increase earnings.

Medical Management Consulting

Improve your facility’s earnings by enhancing the entire medical management process, from admissions notification through concurrent review as well as denials management and appeals. The goal: To ensure insurance company denials are no longer a source of significant earnings loss for your site. Our teams of experienced managed care experts will work with you and your team to understand your unique situation, your current process and your goals for the future. We will then work with your team to enhance your processes to help you achieve those goals.

Claims Recovery Practice

Our team of reimbursement experts, work with our hospital clients to minimize lost earnings from unpaid claims. We typically recover over 50% of unpaid claims. Our value proposition is based on our ability to recover considerably more dollars for our clients at a lower cost, and because our work is contingency based, there is no upfront cost or risk for our clients.

Technology Solutions

Our appeals tracking system ATS is the same proprietary tool we use to effectively manage our hospital clients appeals. Because the tool has been so instrumental in minimizing denials through the appeals process, we are making it available to hospitals wishing to improve their success at denials mitigation. The tool is both a process tool that streamlines the appeals process and an outcomes tool that measures improvements in the process.

Medical management Staffing

Finding qualified and experienced staff for your case management, concurrent review or other medical management activities is very difficult today. As both Medicare and Medicaid fully embrace aggressive denials management our hospital clients will see an increased need for medical management resources. CMC will utilize our many industry connections to source high quality experienced staff that will add immediate value to your organization.