Work

Rural Health Strategies to Optimize Utilization Review and Denials Management

Year: 2025

Type: article

Abstract: Rural hospitals face unique challenges in UR and denials management due to resource constraints, staffing limitations, and payer complexities. Effective strategies can optimize operational efficiency and financial viability. This paper explores best practices in UR, denial prevention, and appeals management, tailored to rural healthcare settings. Some of the key strategies involve leveraging telehealth for peer review, adopting AI-driven utilization review tools, increasing physician engagement, and standardizing documentation practices. Additionally, payor coordination and proactive case management are essential to reduce denial rates. By adopting a data-guided strategy, rural healthcare centers can maximize both revenue cycle performance and patient outcomes.

Source: Zenodo (CERN European Organization for Nuclear Research)

DOI: 10.5281/zenodo.14874258

Authors: Mehul Pahuja, Deepak Pahuja MD MBA

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: green

OpenAlex ID: W6949257967

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