Leading the Industry in Quality and Service

Transcription

1 Leading the Industry in Quality and Service Advanced Medical Reviews has been setting the standard in scope and quality for peer-to peer evidencebased medical reviews since 2004 and utilization management reviews since With the largest and most competent review panel of physicians and allied health professionals in the industry, we pride ourselves on the clinical excellence that we provide our clients. Our large, specialized physician network, spanning all fifty states, is prepared and trained to handle your reviews from the mundane to the most complex. Our easy-to-use and intuitive client interface provides streamlined flexible workflows and strict quality assurance protocols. While providing superior quality reports, our intelligent technology makes sure that your review meets all of your business requirements while adhering to strict SOC2 security standards and HIPPA requirements. Medical Review Types Medical necessity/standard of care Length of stay Coverage issues Experimental/Investigational Workers Compensation Quality of Care/ Utilization/Over-Utilization Pharmaceutical Review Dental Review Billing and Coding/ Usual & Customary Injury/Illness Assessment Medical Chart Medical Imaging What Our Clients Say: Advanced Medical Reviews took the time to understand our business needs and has surpassed our expectations with the results they delivered. The thoroughness and precise attention to medical reviews they provide is simply unparalleled. Moreover, we appreciate their fast turnaround time. Reviews are well-written and give exactly the information we need. As a TPA who needs to deliver cost containment features to clients, and who also needs to satisfy reinsurer requirements, from pre-certification to the most involved high risk large case review services, we have found Advanced Medical Reviews to be pro-active and knowledgeable in all activities.

2 Group Health & Third Party Administrators (TPA s) Advanced Medical Reviews offers convenient, affordable and timely medical reviews customized to your workflow and business practices. Why You Should Partner with AMR Maintaining the industries largest network, our competent and highly-trained, board-certified physicians represent an extensive list of specialties and subspecialties across all fifty states. We provide comprehensive medical recommendations utilizing case-specific patient information and history and industry standard guidelines including treatment protocols and current scientific evidence. We provide CMS compliant reviews including medical necessity and readmissions. We offer Physician Advisors specifically trained in Medicare/Medicaid rules and regulations based upon individual state guidelines. Our expertise extends across multiple lines of business including commercial plans, selfinsured plans, Medicare, Medicaid and ERISA. AMR s customizable technology allow our TPA clients to meet their client s individual needs as well as focus on their business outcomes AMR s internal compliance team is well versed in the ongoing regulatory landscape.

3 Drug Utilization Review Program Advanced Medical Reviews (AMR) Drug Utilization Review (DUR) program offers prospective, concurrent, and retrospective reviews that allows our clients to assess the necessity and safety of drugs and/or regimens. Our panel of physicians and allied health professionals review patients prescription and medication data (and/or OTC drugs) before, during, or after dispensing to ensure appropriate decision-making and positive patient outcomes. Cases are frequently referred for the following reasons: necessity of drug(s), potential interaction of multiple medications, over-prescription, quality-of-care, appropriate opiate use, and fraud investigation. DUR Review Types Prospective DUR (PDUR) is an evaluation of planned drug therapy prior to dispensing. Concurrent DUR (CDUR) is a real-time review of the course of treatment, monitoring drug therapies and patient outcomes. CDUR will alert prescribers to potential problems and drugdrug interactions, duplicate therapy, over or underutilization and excessive or insufficient dosing. The findings from this report may recommend an altered therapy. Electronic prescriber monitoring allows interventions before the drug is dispensed. Retrospective DUR (RDUR) detects patterns in prescribing, dispensing or administering drugs; prevents recurrence of inappropriate medication use or abuse based on current patterns of medication use, prospective standards and target interventions. RDUR improves outcomes and healthcare.

4 Hospital Partners Advanced Medical Reviews is setting the standard for providing high quality, prompt, peer reviews. We specialize in quality peer reviews, offering our clients unbiased, professional assessments. Additionally, we offer medical necessity reviews, (concurrent, retrospective readmission) with an emphasis on getting the appropriate admission status. To meet the needs of our healthcare partners, we deliver our solutions through expert, highly qualified Physician Advisors who are trained in Medicare/Medicaid rules and regulations and have real-time access to clinical and regulatory information. With the largest network of Board Certified Physician Advisors in the industry, we service all 50 states, 365 days a year, 7 days a week. AMR provides comprehensive medical recommendations utilizing case-specific patient information and industry-standard guidelines including treatment protocols and current scientific evidence-based medicine. We provide the following additional services: Interim Medical Directors to help you cover workload and overflow. Peer review that can be customized by facility type and region as required.

5 Workers Compensation and Disability Insurance We believe every patient should receive quality healthcare Advanced Medical Reviews understands that Workers Compensation and Disability cases can be complicated. By offering the largest network of board-certified specialists in the industry, we can handle your most demanding cases, across all workers compensation specialties, including psychology, neurology, pain management, orthopedics and more. By utilizing evidence-based medicine and best practices we excel in clinical quality and our specialty matched network ensures your reviews are not waiting on experts. Our team of experts and our superior customer service and workflow management makes sure that you hit your deadlines and get the reviews you need when you need them.

6 Integrate Your System with Advanced Medical Reviews We believe every patient should receive quality healthcare Integrating with AMR can help address four problems that are common to enterprises of all sizes: Extraneous systems and applications Cumbersome manual tasks Hindered scalability Multiple disparate systems with poor compatibility AMR s clients who have integrated with us have told us they have the following benefits: Increased Revenue through implementing the correct tools, structure, and processes to support optimal data management, thus increasing revenue through enhanced business intelligence. Cost Savings by generally minimizing processing costs through the reduction of cumbersome manual tasks, training issues and improving scalability. Accelerate Innovation by allowing for continued use of legacy systems while capitalizing on the addition of innovative software. Also, a faster, more efficient system leaves room for innovative technology. Quality improving quality through the reduction of manual processes and data input. Agility integrating can allow you to be proactive, with the ability to quickly and intelligently respond to changes in your industry environment. A Snapshot of the AMR Integration Process AMR s integration team works closely with client stakeholders to understand the best possible approach to collecting information and clarifying all necessary integration points. We offer options for real-time and/ or batch integration. Batch integration is implemented via secure file transfer while real-time integration can be attained through standardized web services via secure html.