Jeffrey Hirsch Dec 1, 2017 06:19 AM
I don't know where you're getting the data or how old it is, but this article is wrong on reimbursement for an EKG by approx. 1000%.
GARY BRAZINA Dec 2, 2017 07:50 AM
I have had multiple patients with DM or ASCVD who were to have major surgical procedures DENIED pre op medical clearance! Delayed or cancelled surgery as this "falls below the standard of care" and surgical center regulations.
Chris Siegert Dec 6, 2017 08:44 AM
As an adjuster for an insurance carrier, I don't see any net savings in paying for UR and IMR instead of just authorizing the requested pre-operative testing. Not authorizing the testing will likely delay surgery and delay getting the injured worker to MMI. This results in increased periods of temporary disability and delays return to work. Clearly this type of hyperactive UR does not benefit the injured worker or the employer. I'd like to know which type of "payers" are doing this and why this is being done because it makes no sense to me. Are we talking about insurance carriers or TPAs? Is this UR being requested by people who focus strictly on medical costs or people who look at the total cost of a claim? Of course some testing might not be necessary but this sounds like a systemic problem better addressed by educating providers and not by submitting everything through the UR process.