SFUR offers predictive software (through one of our trading partners) that list those charts requiring review that have the highest probability of documentation error. Once these charts our identified, our physicians review the charts, and the results generate a 4:1 gross return on investment for our hospital customers.
Insurance Utilization Review
The medical Utilization Review/Utilization Management (UR/UM) component for Medicare Advantage, Managed Medicaid and other managed care plans is a critical function that requires medical depth, breadth and resourcefulness. Members of SFUR’s physician panel have been providing Utilization Review for Medicare Advantage plans in thirty-two states for over ten years.
Compliance Fraud Waste Abuse
SFUR is committed to improving the healthcare ecosystem. Both healthcare delivery participants and those entities that pay for healthcare, leverage the knowledge of the SFUR’s physician panelists. Monitoring compliance, fraud, waste and abuse starts with the SFUR physician panelists that can be impartial, objective and current in the knowledge and practice of their respective specialty.
Medical Cost Containment
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.
Healthcare Provider Utilization Review
Even though payers deploy strategies to control physician office and hospital services, hospitals utilize utilization review and management to ensure the optimum use of the facility’s resources and high-quality care.
As value-based reimbursement models become more prevalent, hospital utilization management will take on a more important role.
SFUR provides prospective, concurrent, and retrospective utilization review in the provider community.
Workers Compensation Utilization Review
Utilization Review manages medical aspects of claims in conjunction with ensuring injured workers are provided with timely and appropriate medical care. Over utilization of medical treatment is a driving factor in the overall cost of a Workers’ Compensation claim. SFUR, through the use of licensed nurses, board certified physicians and application of data driven evidence-based guidelines, addresses costs through a proactive approach.