You want your patients to receive the level of care that they need to heal. However, too often, insurance companies will deny needed services. A utilization review team can review medical necessity documentation in order to appeal denials. CodeMax Medical Billing’s utilization management services are an integral part of helping your organization save money, reduce waste, and more effectively care for patients.
In the face of rising healthcare costs, utilization management is crucial. Your clinical expertise and your patients’ needs should be the determining factors of the care your patients receive, not the bottom line of insurance companies.
What Is Utilization Management?
Utilization management involves ensuring that patients get the treatment they need and reducing healthcare waste. Maximizing what insurance will cover is a core part of utilization management, as is ensuring that patients don’t go through unnecessary tests or procedures during their time in treatment.
For substance use disorder and mental health treatment centers, physician’s offices, surgery centers, and laboratories, utilization management can help reduce costs and ensure that all of your services are correctly coded and covered by insurance.
Spend More Time on Patient Care with CodeMaxMB
Our utilization review team is led by an ASAM-certified physician who provides oversight. Some of what we can provide to your business includes:
- A thorough understanding of admissions and continued stay criteria – When patients need more time in treatment, we can advocate on their behalf
- An audit of your current practices – We’ll ensure that you have effective clinical documentation that covers the intensity of services, program scheduling, and other important details
- Help implementing new practices for maximum effectiveness – If your current practices aren’t serving your patients, we’ll help you develop new guidelines
- Explanations of peer-to-peer review processes – Our physician can counter any utilization review medical necessity issues that might be brought up on claims review of appeals
Additionally, we’ll use our existing relationships with care managers at the top providers frequently contacted for UR management.
While there are numerous benefits of our utilization management services, what you’ll notice immediately is the impact on denials. You’ll have more freedom to give patients the care they need knowing that our utilization review team is on your side. By working with insurance companies on your behalf, CodeMaxMB can help you save time as well. You won’t need to maintain an internal billing department. Instead, you can devote more resources to patient care and to improving your processes. In short, utilization management can provide cascading benefits in a short period of time.
Contact CodeMaxMB for Utilization Management Services Today
CodeMax Medical Billing offers all of the coding and billing services you need. Outsourcing your billing department to our experienced team will give you more time to focus on patient care. You can have peace of mind knowing that we’ll handle dealing with insurance, pursuing payments, and working through any legal issues as necessary.
In addition to utilization management, the services we offer include:
- Billing and claims management – We will streamline your collection process and increase your revenue
- Consulting – Our team can identify areas for growth and help you implement new guidelines and processes
- Verification of benefits – Quickly and accurately verifying benefits will help you give patients the care they need when they need it
- Quality assurance – We cross-check and review all documentation to reduce denials and save you money