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Medical Necessity Reviews


CBIZ combines its clinical expertise with data analytics to provide a targeted review of medical necessity.

Our targeted approach to medical necessity reviews identifies those cases that are at the greatest risk for denial and recoupment. Our service provides a focused review and concrete action steps that identify opportunities for performance improvement.

As part of our review, CBIZ’s proprietary data analytics identify claims that may have been assigned incorrect patient status. Our on-staff nurse reviewers then review these specific, at-risk cases. The melding of data analytics, revenue cycle optimization and clinical best practices has created a unique service that helps hospitals and health systems reduce risk and regulatory compliance issues.

This service improves the application of admission processes, increasing the accuracy of patient status assignment, which results in improved regulatory compliance and optimized revenue.