Concurrent Review

As health care costs rise and medical facilities are tasked with increasing demands to provide ever more cost-effective care to their patients, third-party concurrent review services are becoming a cornerstone of robust health care management programs. In concurrent review, the continuation and appropriateness of ongoing patient care are reviewed in real time by informed medical professionals to determine if an overall plan is still effective.

When a hospital’s full-time doctors and nurses are required to conduct concurrent reviews, the task can eat into their limited time — time that’s better spent providing patients with much-needed care. For this reason, more and more health care facilities opt to leverage the skills of qualified independent concurrent reviewers in order to free up their internal staff.

Clearly, a hospital that outsources its concurrent review process is empowered by both the specialists and technology of the reviewing agency. In addition, the facility gains the ability to take cost-effective actions as a direct result of the information the process produces.

What to Consider in Contract Concurrent Reviewers

The decision to continue or discontinue a patient’s care is one of the most critical evaluations made in the medical community. The result of every concurrent review carries with it the potential to impact both the quality of life of the patient and the financial well-being of the organization providing the care. A hospital looking to contract a concurrent review agency must have full confidence in its choice of service provider.

Of course, the agency providing concurrent services should possess sufficient experience and qualified personnel to adequately meet its responsibilities. Moreover, the reviewing agency has to utilize robust data collection technology to ensure all medical records and relevant communications are efficiently and securely handled during the review process.

Finally, in order for requests for continued treatment to be accurately evaluated, both approvals and denials must be assessed in a timely manner that keeps the facility, its staff and its patients properly informed.

HCRS — Your Trusted Concurrent Review Agency

At HCRS we’ve supplied trusted health management services to public, private, governmental and state medical facilities for more than two decades. Our specialized concurrent review teams are comprised of American Health Information Management Association — AHIMA — recognized professionals with years of inpatient and outpatient treatment review experience.

To provide correct determinations, our nurse reviewers have a minimum of five years of concurrent review experience. In addition, we have two DDSs on call to review dental treatment plans as needed.

For matters of great importance including denials, our Medical Director is Board Certified by the American Board of Quality Assurance and Utilization Review. With 15 years of experience as a Medical Director and Senior Medical Director responsible for prior authorization and concurrent review, the Director personally signs off on all medical necessity denials.

Look to HCRS for Exemplary Concurrent Review Services

Quality, transparency and affordability are the pillars of the concurrent review services we supply. For more than 20 years, we’ve helped our clients achieve high-quality and high-value outcomes. Our commitment to your facility’s successful operation is matched only by our professionalism.

For more information about concurrent review services from HCRS, contact us today.