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WCI: Best Practice Hierarchy

Posted by Genex on July 16, 2016

Prioritizing Integration of Utilization Review, Medical Nurse Case Management, Medical Bill Review

This article originally appeared on 07/06/16 on the Workers’ Compensation Institute’s website, and is republished here with permission.

By Amanda Naser

Utilization review (UR) and medical bill review (MBR) have long been viewed as a perfect pairing in workers’ compensation. So much so that the need for integration between the two services has been given much attention by service providers. Today’s most effective workers’ compensation managed care programs have raised the bar by demanding a more impactful strategy. Fostering a hierarchy of best practices can improve managed care program efficiencies, outcomes, and resulting savings. This hierarchy combines utilization review, medical bill review, and medical nurse case management in a different way. Prioritization of when and how this trio of strategies is integrated matters. 

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Topics: Bill Review, Case Management, Utilization Review