Your Questions. Our Answers.
We have answered many of the frequently asked questions that we receive. If you have any further questions, please feel free to give us a call at 1-800-201-1021 and we will be happy to assist you. Or, go to our Contact Page and fill out the information and we will get back to you.
Can AuditEdge™ still help if there is a fee schedule?
Yes. There are gaps and grey areas in every workers’ comp fee schedule. Client’s can benefit from a thorough line by line audit and/or negotiation by a professional auditor.
What if I already have a bill review vendor? Can I still benefit from AuditEdge™?
Yes. We can work in concert with your standard bill review vendor to provide AuditEdge™ specialty bill review and negotiation services. These are an excellent enhancement typically having a significant impact on cost containment.
Aren’t all bill review companies the same?
No. The trend in our industry in recent years is to automate as many things as possible. Unfortunately, automation in bill review means that quality suffers. Our intricate processes and thorough review of each bill ensure every component is considered in audit. This equates to substantial cost savings, reduces appeals, and ensures that everyone “touches” the bill only once.
Isn’t it the software that makes bill review work?
While the software is very important to the process, we believe it is the auditor that makes the biggest difference in the bill review process and appropriate reductions.
I already have an EDI in place. Isn’t it too costly to change?
Review Med and our technical support team build to the specifications dictated by our customer. If you have a current interface in place, we can replicate that with minimal input from you or your technical resources. By taking on the bulk of the work, it will require little effort on the client’s part therefore minimizing or eliminating the cost.
What is utilization review (UR) and why is it used for workers’ compensation?
UR is the process used by employers or claims administrators to review medical treatment requested or preformed for the injured worker, to determine if the treatment proposed or received is medically necessary.
Prospectively (before services are provided)
Concurrently (extension of on-going health care)
Retrospectively (after services are provided)
Why can’t the insurance adjuster conduct the request for utilization review?
Many jurisdictions require organization’s to be certified or accredited to conduct UR. Even when it is not mandated by jurisdiction, having an unbiased third party medical determination by a provider who actively treats injured workers with understanding of the workers’ compensation system, holds a great deal of weight in a hearing.
Does approving a request for authorization as medically necessary mean the provider’s bill must be paid as submitted?
Not necessarily. Utilization Review is not a guarantee of payment. An authorization only means that the reviewer has found the request medically necessary and appropriate. The employer or claims administrator can dispute the bill for reasons not related to medical necessity.
What are treatment guidelines and why are they important?
Medical Treatment Guidelines can vary by state and are the standards of care for treating injured workers. The guidelines are based on the best available medical evidence and the consensus of experienced medical professionals.
Return to Work Guidelines are essential to useful disability outcomes and overall employee health and productivity.
The American Medical Association (AMA) Guidelines are the impairment rating system utilized to determine the overall level of impairment after injury or disease.
What makes Review Med case management different from another case management company?
Our processes and standards set us apart from the crowd. We focus on customer service and provide all services on an individualized basis to meet our client’s needs. Our successes prove we are the premier leader providing disability management services.
What specialized services do you have to support my program?
Review Med offers case managers who are familiar with Workers’ Compensation, Defense Base Act, Catastrophic, LTD, and Inland Marine. Also, our case managers have clinical expertise in various areas of nursing care with an average experience base of 16 years.
What credentials do you require for your case managers?
We require our case managers to be a RN or a Vocational Rehabilitation Counselor as well as having an appropriate certification such as CCM, CRC, CIRS or CDMS.
We are a national company. Can you accommodate our needs nationwide?
Yes. Review Med offers national coverage to “bridge the gap” for an injured party and ensures that appropriate treatment, support and case resolution are efficient and cost effective.
Did you Know?
We offer a “boutique” service allowing our clients to customize their program? We can receive any referral via email, ftp, fax or have an account manager pick it up? Our savings for bill review exceeds our competitors. Ask us how.