Cost Containment Solutions
Industry Partners Services Overview
SFUR works closely with Cost Containment Services, Consulting and Technology Companies to extend the partner’s offering to include Medical Necessity based Medical Cost Containment, Utilization and Compliance Services. Our strong Physician based review services through our 800+ Physician panel covers every medical specialty and geographic requirement.
SFUR fully supports our partners teams to offer their customer the SFUR complement of cost containment and medical utilization management services.
Leaders in URAC Certified Medical Utilization Review
For 30 years we have provided nationwide Medical Utilization Review Professional Services, applying Medical Practice and Financial knowledge to improve our customers’ process, outcomes and financial results.
We are a member of the National Association of Independent Review Organizations (NAIRO), an URAC Accredited Independent Review Organization, employing Board Certified Physician Specialists, Certified Medical Audit Specialists and Certified Professional Coders. We continually strive to improve and innovate our services to best meet our customers’ ongoing challenges.
We are committed to the highest quality work product and aspire to exceed our industry’s URAC and CPC Certification requirements.
We are confident that we provide our customers the best price with the highest quality results of all Certified Utilization Review Companies.
Industry Partner Cost Containment Solutions
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.
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.
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.
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.
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.
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.