AllMed Healthcare Peer Review – Doctor, Physician, Nurse, and Hospital Peer Review.
AllMed Healthcare, an Independent Review Organization (IRO), providing doctor, physician, nurse, and hospital peer review services, has released its September 2004 Medical Review News.
(PRWEB) October 27, 2004
AllMed Healthcare, an Independent Review Organization (IRO), providing doctor, physician, nurse, and hospital peer review services, has released its September 2004 Medical Review News.
The newsletter contains the following peer review articles of interest to Claims Managers, Claims Administrators, and Medical Directors at Health Plans, Third Party Administrators, Utilization Review Companies, and Medical Management Companies.
Outlines of the peer newsletter articles appear below. Click on the following link to subscribe to the AllMed Newsletter: http://www. allmedmd. com/company/newsletter/0409/press/index. htm (http://www. allmedmd. com/company/newsletter/0409/press/index. htm).
Article #1--Eyelid Surgery (Blepharoplasty) Peer Review
-When is it medically necessary to have Blepharoplasty?
-What red flags should a case manager / claims administrator be aware of when it comes to Blepharoplasty?
-How does an Independent Review Organization help in the review process for questionable cases of Blepharoplasty?
-What are the top questions a claims manager should ask its Independent Review Organization when making claims decisions on Blepharoplasty?
Article#2-- Hospital Stay Claim Peer Review
-What is the impact of the last day of a hospital stay as it relates to medical claims administration?
-When does it make sense for a claims manager to challenge the coverage for the last dayÂ’s stay?
-What other options does an insurance company have to help reduce hospital stay costs?
-How can an Independent Review Organization help with these cost reductions?
Article#3--Regulatory Review (Peer Review)
-Under ERISA and DOL, when is an insurance company or healthcare payer required to send out a case for medical review by an external review organization?
-Why must this be an arms-length medical review?
-How do these regulations affect your organization?
-How can an Independent Review Organization help expedite the claims review process?
AllMed provides peer review opinions that quickly resolve complex problems -- saving money while protecting the integrity of patient care. AllMed will review chart notes and operative reports to render objective written opinions; help you reach the right decision while reducing legal risk; apply your plan language to the case, if appropriate, give you direct access to our physicians for questions and follow-up on peer reviews; and supply clear, professional and easy-to-read documentation. AllMed also applies the same high quality standards to its medical review, pharmacy review, medical bill auditing, and medical director review services.
About AllMed:
Allmed reviews claims for issues of medical necessity, standard of care, experimental / investigational, hospital quality management, code unbundling, fraud, and other issues that affect healthcare decision-making.
AllMed Healthcare has trained peer review specialists in the following specialties: Acupuncture, Allergy/Immunology, Anesthesiology, Audiology, Bariatric Surgery, Bone Marrow Transplantation, Cardiology, Cardiovascular & Thoracic Surgery, Chiropractic, Dentistry, Dermatology/Dermatopathology, Diagnostic Radiology, Electrophysiology Cardiology, Emergency Medicine, Endocrinology, Forensic Medicine, Gastroenterology, General Surgery, General, Vascular & Thoracic Surgery, Hand Surgery, Hematology/Oncology, Heart Transplant, Infectious Diseases, Internal Medicine, Interventional Cardiology, Kidney Transplant, Liver Pancreas Transplant, Neonatology, Nephrology, Neurological Surgery, Neurology, Obstetrics/Gynecology, Ophthalmology, Oral & Maxillofacial Surgery, Organ Transplant, Orthopedic Surgery, Orthotics/Prosthetics, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endrocrinology, Pediatric Gastroenterology, Pediatric Nephrology, Pediatric Neurology, Pediatric Ophthalmology, Pediatrics, Pediatric Surgery, Perinatology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Prosthodontics, Psychiatry, Psychology, Pulmonary Medicine, Radiation Oncology, Radiology, Rheumatology, Sleep Disorders, Speech & Language Pathology, Toxicology, Transplant Surgery, and Urology.
# # #
