|Ask for a free consultation with one of our experts.
Utilization Management plays an integral role in today’s care and reimbursement models. BHM works with providers and payers through the many facets of claims review, which gives HM the big picture understands needed for successful UM.
Utilization management (UM) is crucial facet of the healthcare ecosystem. It ensures that healthcare systems are running efficiently and providing a standard level of care. Overall, utilization management is critical for ensuring that an organization is not only reducing denied claims, but catering to patients’ preferences and providing proper care.
“Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan, sometimes called “utilization review.” – URAC
Key Benefits of Utilization Management
- Ensures organizations are continuously improving
- Focuses on delivering appropriate levels of care
- Improves clinical outcomes
- Lowers costs
- Improves communication between payers, providers, and insurers
- Enhances quality of care
- Eliminates excessive or unnecessarily procedures or treatments
Best Practices in UM…
- Consistent use of UM Review for every patient
- Highly trained and educated staff on documentation processes
- Use data for appeals, including Conflict of Interest documentation
- Proven success ensuring quality of care and cost containment
- Review lost appeals for internal process improvement