Utilization Review–A Nuisance or Cost Saver?
- 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,
- “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,
- 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.