Utilization Review–A Nuisance or Cost Saver?


UR, when done right;

  1. In many situations will convince providers early on to voluntarily withdraw a request.  Communicating/suggesting revised treatment protocols saves money on denials/appeals and improves outcomes,

  1. “Follows” (with voluntary participation) a patient after the approved procedure has been implemented.  Any chance to improve communication, reduce misunderstandings and increase compliance with medical directions improves  outcomes,

  1. Doesn’t hide from the co-morbidity issues (obesity, diabetes, smoking, hypertension, addictions) that diminish outcomes.  Focusing just on a single requested procedures can miss the big picture a workers’ comp or group benefits carrier needs to address in order to improve  outcomes.

Posted in Medical Cost Containment, OMCA