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Medically Necessary |
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We believe
appropriate utilization is
an inherent and
critical component
of clinical quality.
Utilization review
ensures that fine line is
navigated appropriately.
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Computerized tools, trained professionals (RNs, RHITs, certified coding specialists, physicians), and comprehensive reporting options offer a cost-effective and responsive medical and health care utilization review outsourcing solution.
Some view utilization review merely as a cost containment strategy, therefore inhibiting quality of care. Due in large part to our background in health care quality improvement, we feel the opposite is true, that appropriate utilization is an inherent and critical component of clinical quality. Permedion's health care utilization review experience includes providing essential services to large payors, such as state Medicaid agencies, encompassing review of inpatient hospital, outpatient hospital, home health, and other services. In collaboration with our clients, we strive for measurable improvements in appropriate utilization, while identifying reimbursement for unnecessary or inappropriate services. |
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In addition to our experienced staff, computerized abstraction tools, and advanced reports, Permedion clients benefit from our ability to see the bigger picture of health care value (VALUE = QUALITY/COST).
Permedion's highly qualified and experienced health care reviewers can coordinate the entire retrospective medical utilization review process-from record requests and retrieval to medical record abstraction in the field. Permedion has developed an extensive core staff of RN, RHIT, and certified coding specialist reviewers, as well as the ability to assemble complementary review teams throughout the country. A panel of over 400 board-certified physicians provide support for denials and complex cases.
Ongoing quality assurance is spearheaded by interrater reliability tests, among other processes. Statistical analysis is also used to target specific categories of care, to apply profiling and pattern analysis to abstracted data, and to support focused studies of utilization issues (e.g., use of Emergency Department services or standards-based diabetes care).
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Computerized Abstraction Tools
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Permedion invests significant time and resources into building sophisticated abstraction tools and applications for use on PCs and portable computers.
Delivering advantages in accuracy, efficiency, and speed, our computerized tools feature:
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Online help screens and reference materials
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Online criteria (standard or customized) and
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Real-time edits
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Permedion encourages its clients to use UR processes to educate providers and change behavior. While recoupment of funds is the most visible product of utilization review, in most of our contracts, we collaborate and share information with providers to prevent misuse of valuable resources and improve care.
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Concurrent Review |
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For non-prospective payment systems (e.g., DRGs), concurrent review while a patient is in a health care facility can ensure an appropriate length of stay and that services delivered are medically necessary. Scheduled exchange of information between the facility and Permedion facilitates monitoring of the patient's progress and quality of care.
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Prior Authorization
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A complementary component of retrospective utilization review is precertification, another area in which Permedion possesses large-scale experience.
Learn more
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For More Information or Pricing
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Please call Dennis Gramlich at (800) 473-0802 or contact us electronically. Go
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Learn About Other Permedion Services
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