Rural Health Strategies to Optimize Utilization Review and Denials Management

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.