Not all utilization review (UR) providers are created equal. Choosing the right one can mean the difference between frustrating fees and penalties for noncompliance and an effective and efficient medical management process. Here are four qualities to look for when choosing a UR partner:
1. They’re ahead of the curve on industry changes
Insurance companies strive to operate in compliance with the complex rules and regulations that govern the industry. Noncompliance results in fines and penalties and can lead to censure in health care publications, damaging your business’ reputation. Choose a UR partner that has expert knowledge of regulatory requirements and understands that compliance is critical.
In workers’ compensation, regulatory changes are constant as legislators continually try to improve standards and guidelines. In 2012 alone there were more than 10 state changes affecting insurance companies. Attention to compliance means staying ahead of the changes, keeping your organization informed about upcoming changes, and having solutions ready when those changes take effect.
2. They have the experts you need to back you up
Look for a partner with nurses, physicians and executives who are committed to providing evidence-based decisions that stick. Are members of the team familiar with rules and regulations for all of your jurisdictions? Is there a quality initiative in place? Is there a steady focus on high quality claimant care and positive outcomes?
3. They respond quickly to your needs
Choose a UR company that will address your needs immediately – not in six months or a year. Time delays result in noncompliance penalties. Find a company that is will help you adapt quickly to industry changes. For example, the Texas Department of Insurance recently announced a new rule that took effect just five days later. The right partner will not only take action to keep you in compliance, but will keep you abreast of impending changes and solutions for handling them.
4. They tailor their approach to you
A strong partnership and a fully integrated medical management process will create an environment for a successful operation. With best-practices UR your operation can run efficiently and profitably while ensuring injured employees receive high-quality medical care and optimum outcomes. Take the time to find a strategic partner that asks about your needs, listens to your answers and customizes solutions for your company. Make sure your UR partner employs experts you can count on.
Effective medical management is no longer an option – the stakes are high and the consequences of sub-par UR are costly. The workers’ compensation landscape is replete with regulations and barriers to saving on medical and claims costs. But companies can turn those challenges into sustainable success by choosing a UR partner that ensures compliance, insists on evidence-based decisions that stick, and has experts ready to back you up.