How do Medical Review professionals keep up?

Rayellen Kishbach's picture

The ever-increasing pace of healthcare benefit and coverage policy change makes it harder than ever for medical review professionals to make quick, completely informed policy and reimbursement decisions. Without the right information and tools, your organization’s exposure to risk increases. This risk is multiplied when you have to monitor and comply with updates across multiple states. Medicare Administrative Contractors change their coverage determinations and articles weekly, and keeping up with Medicaid is even more frustrating - with over 50 different web sites, layouts and update schedules to master! As Director of Customer Success, I've worked with dozens of medical policy teams, from health systems to payers, to life science companies who wish to provide their clients with accurate information. Here are some of my lessons learned:

1. Knowing what you don’t know is half the battle

In both the Compliance Suite and the Coding Suite, MediRegs clients have access to an on-line library that contains comprehensive federal and state information - including Medicaid Manuals and Local MAC Coverage Determinations and Articles for all 50 states, as well as national coverage information and drug resources. Integrated state and federal content allows our clients to use a single reference tool to access all of the information needed without having to learn multiple websites and navigation features. Coding comes into play as well -- which is why our system allows you to search by key word, synonym or code to find what you need, including a Code Explorer tool that simplifies finding the right codes and seeing what has changed. Clients call this “one stop shopping” and love the simplicity.

2. Complete decision making requires complete knowledge

But sometimes "complete" can feel "overwhelming". That's why we've housed our benefit, policy and coding references in an intuitive interface which allows for fast, easy, and targeted access to information. Content is robust and all inclusive, but can be tailored by state, subject, and content type. Bookmarking allows you to save what you have found, and even organize your favorites into folders for easy reference. Rather than always searching, I worked with a retail pharmacy client to help bookmark key sections of each state's statutes, code and Medicaid manuals for one-click access to what is needed. For more universal topics, clients appreciate the virtual research assistant pages we provide with pre-configured bookmarks by topic.

3. Real-time decisions require real-time information

All of our products include Daily Alerts to keep you informed about changes in health care regulations, compliance, and coding information. This is helpful, but can also be a large volume of information, particularly at the turn of the year and quarter when CMS and AMA publish large volumes of code changes. This is where our Stored Search feature can be so helpful for medical policy staff. In addition to bookmarking the existing documents that are useful, our clients can store customized searches for daily or weekly information. I've worked with a number of medical policy teams to identify code, term and concept lists, and mapped intelligent searches to generate instant alerts when a company policy requires re-examination.

Training & Support on our products is always free, so I'd love to invite you and your team to a customized session where we can take a careful look at the medical policy and other issues you have to track, and configure your account to let us do the heavy lifting with bookmarks, stored searches, and personalized alerts sent directly to you. Reach out any time.

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