Utilization management services
A service that preserves providers' revenue by helping them choose the best care settings for maximum reimbursement using prospective reviews.
Utilization management (UM) is an approach that analyzes each treatment, service, operation, and facility that is provided to a patient and decides whether it is effective, suitable, and medically necessary. Instead of doctors, this process is handled by or on behalf of those who pay for medical care (insurance companies). UM has an impact on patients, medical staff, insurance, and hospitals.
Achieve Market-Leading Outcomes And Optimize Care With MedAR Resolve As Your Reputable Utilization Management Partner.
When it comes to ensuring the delivery of excellent care while keeping costs under control, MedAR resolve understands the significance of efficient and effective healthcare usage management.
Our utilization management solutions are made to support healthcare payers in maximizing utilization, enhancing patient outcomes, and increasing operational effectiveness.
Types of Utilization Management
UM has three main types of reviews: prospective, concurrent, and retrospective. The Donabedian model of quality of healthcare, created by Avedis Donabedian in the late 20th century, is comparable to this structure. Different reviews can have different effects on the procedure.
Prospective Review: Conducted on a case-by-case basis before or at the beginning of treatment, this review attempts to cut out services that are not required. The chosen course of treatment should be viewed as provisional and subject to change.
Concurrent Review: This kind of review follows a patient’s development and resource use throughout the course of treatment; it may result in the suspension of ongoing care operations.
Retrospective Review: Conducted after the course of treatment is complete, the review analyzes the legality and efficacy of the course of treatment in order to provide information to new patients.
Are you prepared to maximize the use of healthcare resources, better patient outcomes, and increase operational efficiency? To find out more about how MedAR Resolve’s Utilization Management Services can help your business, get in touch with us right away. Our team of professionals is committed to assisting you in maximizing utilization, raising the standard of service, and promoting operational excellence.