Hospital Peer Review

Managed Medical Review Organization now offers a peer review program for hospitals wishing to avail themselves of this service. This program has been found to be particularly helpful to hospitals that may not feel confident that their internal peer review process is an effective one. Through this program, MMro is able to review, with absolute confidentiality, medical records that may need particular scrutiny. Peer review findings are sent back to the originating hospital with comments and recommendations for improved care. This program has added a much-needed element of professionalism and objectivity to the peer review process.

Review Issues Addressed

MMro provides specialty- matched, expedited or standard medical reviews that address the diverse coverage disputes, such as:

Medical Necessity
Pre Authorizations
Hospital Admissions
Length Of Stay
Level of Care
Cosmetic Treatments
Transplantations
Experimental Procedures
Investigational Procedures
Procedural Coding
DRG Provider Reimbursement

Services

MMro provides the services listed below for prospective, concurrent, and retrospective medical reviews. These services are available in standard as well as expedited time frames

Utilization Management (Internal Reviews)

Adverse Determination
Experimental Reviews
Initial Determinations
Medical Necessity
Psychiatric Reviews
Transplant Reviews
Length of Stay Reviews
Covered Benefit Disputes
Reconsideration's
First Level Appeal
Second Level Appeals
Cosmetic Treatment Reviews

Independent Review (External Reviews)

External Appeals
Grievance Appeals
Level III Appeals
Independent External Reviews (provides hospitals & physicians with an objective opinion free of internal politics)

Quality of Care Reviews

Coding & Treatment
Quality of Care Reviews
Peer Reviews

Medical Bill Review

As medical cost continue to increase in an accelerated fashion, so does the importance of having ab effective and cost conscious tool used to facilitate the adjudication and resolution of a medical claim. Medical bill review consists of technical review, professional review and peer review if necessary.

Out Of Network Bill Review

MMro provides services to insurance carriers, Taft Hartley Funds and local unions for members who are treated outside of their network. Claims are reviewed along with medical records by our team of professional coders, billers, nurses and physicians to obtain the optimal savings. Line by line "audit" is performed along with medical records for accuracy, fraudulent billing, double billing, bundled charges and billing errors. Claims are NEVER audoadjudicated!