Utilization review, or the process of reviewing an episode of care, is often necessary to justify charges and payments to an insurance company and can also be valuable in determining the best course of action to care for a patient. Encouraging complete documentation and oversight is paramount to running a successful practice. The system of checks and balances that utilization review symbolizes ensures that the best care is provided to your clients at all times. A completed utilization review in healthcare will provide valuable information and insight into how you’re caring for a client and if everything you’re doing is medically justified.
At RevWerx, we stand alongside our clients to collaboratively complete utilization reviews and ensure that your patients are receiving the best possible care. We understand that the process can be difficult, time-consuming, and confusing for those new to it. This is why we strive to support our clients by building confidence and finding solutions to help your team complete utilization reviews accurately and efficiently. If your organization or facility is finding that utilization reviews are slowing you down, we would love to step in and help. Visit RevWerx online to complete our secure form, or call us today at 833.309.0138.
The Importance of Utilization Review
Without comprehensive utilization reviews, your facility or practice would have difficulty determining how best to care for a patient. These reviews exist to ensure that patients get the best possible care from their healthcare provider and that the care is suited to the patients’ individual needs. Mental healthcare providers know that each client is unique, regardless of similar or identical diagnoses. The best care for Patient A may not be well-suited to Patient B, and vice versa. A utilization review can help identify those differences.
Utilization reviews are also often required for health insurance providers, particularly for Medicare. Completing one can help guarantee that a given provider will cover the cost of care. Having that documentation ahead of submitting a claim can be incredibly important in maintaining an efficient system. It also provides a system of accountability for potential disagreements. Having your procedures as well as information about the client and their needs in hand can be the difference between a rejected claim and an approved one. Utilization reviews also minimize costs, ensuring that a patient or client is not receiving care that’s unnecessary or superfluous to care already administered.
Support from a UR Nurse
A good utilization review nurse can be your most valuable ally in facing down an insurance provider. The UR nurse is who analyzes the patient’s care and determines how best to provide for them. That nurse then communicates with another UR nurse employed by the insurance company to come to an agreement about the claim. The two will discuss what care was provided and how medically necessary it was. If they disagree, there is a system to allow physicians to discuss the medical necessity of the care or allow the decision to be appealed. Having a UR nurse at your side can help ensure that your facility or practice is operating as well as it possibly can.
RevWerx has a UR nurse on staff, and when you work with us, our UR nurse becomes your first lieutenant when communicating with insurance companies. Our staff is an asset to yours, and that makes RevWerx a leader in the healthcare RCM industry. If you’re interested in working closely with a team that will create and implement an individualized plan for your organization that works for you, contact us today by calling 833.309.0138 or by visiting us online today.