Cost Containment ServicesCase Studies Case Study Summary - Utilization Review Cases The purpose of Utilization Review is early identification of potential high-dollar and high-risk procedures and services. We target and medically manage the plan’s most costly services to determine medical necessity and review the proposed plan of treatment for medical appropriateness, determine whether the services should be provided and if…

Cost Containment ServicesNurse Advocate Line The Nurse Advocate Line serves as a health information and educational service, sounding board, and referral and recommendation resource. Medical Rehabilitation Consultants' specially trained registered nurses will listen to the insured member, address their concerns and questions, and discuss the issues and options as they relate to their medical concerns. The nursing staff will provide…

Cost Containment ServicesBetter Baby Program Medical Rehabilitation Consultants has instituted a valuable benefit that can be included with the precertification/preauthorization review for monitoring all of your pregnant members. The program goals and our focus are on healthy outcomes. This program is a natural extension of the Utilization Management program and provides early identification of potential high-risk pregnancies. Our nursing staff…

Cost Containment ServicesMedical Trust Advisory Medical Rehabilitation Consultants can serve as advisors of medical Trust Advisory Committees. Their knowledge of medical issues, rehabilitation procedures and lifelong care needs can provide valuable information in determining the appropriate needs and expenditures of an individual. Medical Rehabilitation Consultants can also serve as short-term consultants to assist with obtaining necessary services, resources, care and…

Cost Containment ServicesPredictive Modeling Program Medical Rehabilitation Consultants utilizes proven predictive modeling software to predict health risk/cost by member and stratify members into risk groups allowing us to identify and focus on the sickest, most costly patients and to manage total claims costs. This application applies evidence-based clinical rule sets and advanced mathematical processes to claims, membership and other data…

Cost Containment ServicesDisease Management Medical Rehabilitation Consultants utilizes a systematic, integrated approach to identify those at risk for a particular chronic disease. Based upon the diseases identified for a specific insured group, as well as those diseases that are common, this education-based program will provide education to your members in written and verbal format. A toll-free telephone number is provided…

SFUR defines medical cost containment as the process of leveraging medical and business knowledge to potentially lower the cost of medical bills.

We provide review, assessment and negotiation of medical cost, using  a variety of methods which include,  Separation of Charges,  Coding Validation, Medical Necessity, State & Payer Specific Rules and Reasonable Charge Analysis.