Versalus Health was founded to address the “blind spot” of the revenue cycle: the complex intersection of clinical decisions, regulations/contracts, and billing/finance. Utilization Management is often tasked with bridging the gaps and hand-offs among these functions but is not given the right tools or expertise to be fully successful. By leveraging advanced analytics and unparalleled knowledge, Versalus Health helps hospitals optimize the utilization management role in the revenue cycle. Our solutions enhance compliance, increase efficiency, ensure appropriate revenue and improve results across all payer types.
Versalus Health is led by Drs. Robert Corrato, Joseph Zebrowitz, and Thomas McCarter, the founders and leaders of Executive Health Resources (EHR). Starting in the late 1990’s, they developed the practices still being followed by most UM departments today and introduced the role of the Physician Advisor to the industry. Along the way, they had the privilege of working with nearly sixty percent of all acute care hospitals. They are recognized as clinical, regulatory, and revenue cycle experts with extensive experience with Medicare, Medicaid, and Managed Care.
After departing EHR, the team spent time listening to the market and had several key realizations that led to the creation of Versalus Health:
- Many hospitals are fatigued with high-cost Physician Advisor outsourcing and have built in-house Physician Advisor teams to complement Utilization Management. However, they lack the analytics, expertise, tools, and/or content necessary to get the most out of these teams and ensure compliance and revenue integrity.
- Regulations changed, and the Utilization Management and Physician Advisor processes, content, and metrics needed to evolve as well, but most vendors and internal models are still following a similar process as recommended more than a decade ago. This creates compliance and revenue risk.
- Managed Care contracts have varying incentives and complexities and require payer-specific strategies for Utilization Management and Physician Advisor efforts. The “one-size fits all” approach of applying screening criteria followed by a Physician Advisor review often has unintended consequences.
- Many organizations have limited visibility regarding where their compliance or revenue vulnerabilities lie and are surprised by QIO or payer audits.
- Hospitals can take control of their compliance and revenue integrity performance with the right analytics, processes, tools, and on-demand expertise; and, they can typically save relative to their existing processes or vendors today.
Versalus Health addresses these issues with comprehensive solutions focused on the intersection of utilization management, revenue cycle, and compliance. By leveraging advanced analytics, and expertise, Versalus Health ensures hospital clients achieve optimal performance.
What We Bring
While the available data and analytics hospitals have has leaped forward in recent years, most Utilization Management (UM) departments are capturing only a fraction of the potential value from the data at their fingertips. Versalus changes that. We have developed sophisticated algorithms to extract value from hospital data to help our clients change processes, identify risks, and uncover opportunities.
Deep Industry and Functional Expertise
Beyond models and data, we understand industry regulations, billing requirements, and provider-payer competitive dynamics. This knowledge enables us to translate insights from analytics into actionable solutions to generate results for our clients.
A Singular Focus: Exceeding Client Expectations
Our flexible solutions complement hospitals UM departments by supporting their case managers and physician advisors. Our goal is to optimize your revenue cycle program enhancing compliance and revenue integrity while eradicating your revenue cycle blind spot.