AppriseMD

AppriseMD is a physician-owned and operated company specializing in utilization review and denial management services for hospitals and health systems. The company provides licensed, board-certified physician advisors with experience in both payer and clinical settings to help healthcare organizations optimize reimbursement, reduce claim denials, and improve revenue cycle performance.

The company's services include second-level utilization reviews, payer peer-to-peer reconsideration, Medicare short stay chart audits, discharge reviews, appeal reviews, and utilization review education. AppriseMD offers flexible engagement models including remote support, full-time support, and coverage for nights, weekends, and holidays. Their physician advisors conduct medical necessity determinations and provide documentation aimed at identifying denial root causes.

AppriseMD has published extensive research on Medicare Advantage compliance with the Two-Midnight Rule, the use of AI in claims denials, and Inpatient Only (IPO) list compliance. The company emphasizes timely reviews that complement existing hospital workflows and physician-driven analytics to reinforce revenue integrity.

Choose AppriseMD when your organization needs physician-level expertise to address persistent denial issues and revenue cycle challenges. Their physician advisors can provide the clinical credibility necessary for effective peer-to-peer discussions with payers, particularly for complex medical necessity determinations.

Expect a service model that integrates with existing workflows while providing physician-driven insights into denial patterns. Their research publications suggest deep expertise in Medicare Advantage denial management and regulatory compliance, making them particularly valuable for organizations facing challenges with MA payer denials.

AppriseMD operates exclusively in healthcare, specifically focused on hospital utilization management and revenue cycle optimization. The company demonstrates deep expertise in healthcare compliance requirements including HIPAA, Medicare regulations, and the Two-Midnight Rule. Their extensive research on Medicare Advantage payer behavior and CMS regulatory changes reflects specialized knowledge of hospital reimbursement dynamics and regulatory compliance challenges unique to acute care settings.

Hospitals and health systems with significant Medicare Advantage patient volumes experiencing high denial rates or Two-Midnight Rule compliance challenges. Organizations seeking to augment existing utilization management teams with physician-level expertise, particularly those needing extended coverage for nights, weekends, and holidays. Health systems looking for data-driven insights into denial root causes and revenue cycle optimization.