The Role of Utilization Management in a Healthcare Facility
When you need to ensure your health care services are cost-efficient and compliant, you must clearly understand the process of utilization management (UM). Many changes have been made in the healthcare industry, but UM should still be an essential part of your management program. This complex process will improve the quality of your services, the health of your patients, the satisfaction of your employees, and reduce costs.
What Is UM?
As you may already know, UM is a complex but necessary process that ensures patients receive the best possible care, without unnecessary tests and costs. A good team can evaluate the value of the treatment each patient receives, lower costs, reduce denials, and improve patient care. Having the right team on your side can also ensure compliance and increase efficiency among your staff. A strong team is exactly what you will get when you contact Integrity Billing. We understand the true nature of your operation. Our background includes behavioral health, medicine, surgery, and chiropractic care.
In greater detail, here are just a few ways our team can help yours.
Reduce Healthcare Costs
With the increasing rise of healthcare costs, teams are looking for ways to save money without sacrificing patient care. Lowering costs can come in multiple forms. Our management program is thorough when it comes to saving your medical organization money. We will review all claims and services that patients receive to ensure they are medically necessary, which will also reduce claim denials.
Better Adherence to Regulations
As a healthcare organization, your team must adhere to multiple regulations. A comprehensive utilization review plan will help you stay compliant with all regulations. A utilization review plan is a requirement by the Centers for Medicare and Medicaid Services (CMS), so if your organization participates in these programs, we will make sure your review plan meets all the necessary requirements.
A UM staff is essential for reducing the number of denied claims in several ways. They can:
- Review medical cases and provide modifications when necessary
- Ensure proper documentation to prevent missing or incomplete information
- Evaluate and approve treatments that will receive fewer denied claims
Improve Patient Care
No patient wants to pay for unnecessary treatment or treatment that simply does not work. The UM team is critical in this aspect, as well, because they review the best possible results of individual treatments and whether they are the best option for the patient. As any professional in the healthcare industry knows, finding the right treatment for their patient will yield positive patient results.
Comprehensive UM Programs Matter
There are a few types of UM and each one is necessary for healthcare quality. Reviewing treatments for effectiveness is an important goal of an efficient UM team. For this and many other reasons, a properly managed team can benefit the patient, the medical staff, and the insurance provider.
Contact Integrity Billing
Our goal is to address the needs of medical facilities so you and your staff can focus on patient care. We are committed to protecting your business revenue by working beyond traditional billing throughout the billing and collections process. Depend on us for better revenue management. Contact Integrity Billing or call (866) 413-1559.