Utilization Reviews
Utilization Reviews
Utilization Reviews
Utilization reviews are when an organization wishes to know how well equipment, staff, and resources are applied to the efforts of providing quality health care. Proper billing and coding are very important because this is the lifeline for revenues. If you processing is not in compliance because your billing and coding procedures are inaccurate your cash flow from insurance reimbursements will suffer. Even the normal processing time line for turnaround are becoming almost unbearable from the point of view of the practice or clinics that are waiting to get paid. When mistakes are made this strongly increasing the turnaround time lines for settlement. A simple mistake may cost, in terms of delayed payment times, up to two or three months. Proper medical reviews and audits of the billing and coding procedures will eradicate this source of removable error. The best way to deal with this problem is to conduct regular and timely reviews of the billing procedures, the coding process, and the underlying medical records documentation. In this way you will be assured of compliance with all the proper procedures and can identify problem areas before they become excessive.
This audit record review is also a way to train all the professional in your organization, be they doctors, nurses, clinical staff, or administrative personnel. They learn from the medical review procedures what they have done wrong, what mistakes were made in coding and can apply what they learn to improve the overall system throughput in the future.
In addition to catching errors, the medical records reviews can help establish the policies and procedures that show be followed in the coding practices and the billing of service for reimbursement. Specialized audits of ICD-9-CM and CPT coding assist practitioners and clinics of varying levels of expertise and business activities, to reduce problems that occur in mistakenly upcoding a procedure, and lessen the denial rates and suspension risk.
Utilization reviews provide the organization with hard data on the systems practices which when combined with the analysis of the billing and coding procedures helps to make sure that all resources are used efficiently in the best interests of the patients and the organization.
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