Benefits of Medical Peer Review
Outsourcing medical reviews
Medical ReviewStream™ serves a variety of clients, each with a unique set of needs. Whether you are a utilization review company, insurance carrier, third-party administrator, or self-insured employer, we can provide the level of service you are looking for, no matter what your need. If your needs fit any of the scenarios below, Medical ReviewStream™ may benefit you:
- You already have medical peer reviews outsourced, but want to consider other providers for quality and/or cost reasons
- You provide utilization review and peer review in-house, but want to outsource the service to save money and labor
- You provide these services in-house, but need periodic help with overflow or backlogged cases
- You need a medical review service and want to select the best service provider
Time Savings = Cost Savings
Your UR nurses may be spending anywhere from 30 to 60 minutes on each case that requires peer review. For each case in question they must:
- Locate an experienced, qualified advisor to perform the review
- Find out if the advisor is available to accept a case
- Forward a request and clinical records
- Follow up with the advisor
- Review the advisor's determination for spelling errors and responsiveness to the request
- Reassign any reconsiderations and/or appeals
Medical ReviewStream™ can perform all of the tasks listed above, saving your nurses valuable time. Moreover, this does not include the additional savings in provider network management and medical oversight expense.
Physician Advisory Reports
As the primary deliverable of the Medical ReviewStream™ service, the content and analysis provided by the Physician Advisory Report is paramount. This report can include the following:
- Reported History — The Medical Advisor provides necessary background information that includes both documentation of key dates and context for the assessment to follow.
- Contact — Recorded in this section are the contacts the Medical Advisor makes during the review process, including specific contact information. When necessary, the Medical Advisor will contact the treating physician, which promotes an even deeper understanding of the case and/or the mindset of that physician. This promotes collaboration during the process, involving input from key stakeholders before the final determination.
- Medical Records Reviewed — The Medical Advisor reviews all provided medical records that relate to the injury or condition in question.
- Conclusions — In this section of the report, the reviewing Medical Advisor provides and documents a complete clinical rationale with each determination. Medical ReviewStream™’s program draws upon both internal and independent external Medical Advisors. For the purposes of oversight, quality assurance, and process management, these Medical Advisors employ a medical management model under the direction of our National Medical Director.
- Criteria Utilized — Each Physician Advisory Report documents the appropriate, evidence-based criteria upon which the conclusion is based.