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Utilization Review

Healthcare Provider Services

Utilization Review

URAC Accredited Independent Review Organization

Utilization Review is the process of making sure health care services are being used appropriately, with high-quality care administered as economically as possible and in accordance with current evidence-based care guidelines.  

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.

600+ board certified Physician Specialists

All Medical Specialties Available

Providing Utilization and Peer Review Services for 25+ years

URAC Accredited Independent Review Organization

Member of the National Association of Independent Review Organizations (NAIRO)

OUR CURRENT PHYSICIAN SPECIALTIES

  • Anesthesia
  • Bariatric Surgery
  • Cardiology
  • Cardiothoracic Surgery
  • Colon Rectal Surgery
  • Emergency Medicine
  • Family Practice
  • Gastroenterology
  • General Surgery
  • Hematology
  • Infectious Disease
  • Internal Medicine
  • Interventional Cardiology
  • Neonatology
  • Nephrology
  • Neurology
  • Neurosurgery
  • OBGYN
  • Ophthalmology
  • Orthopedic Surgery
  • Otolaryngology
  • Pediatrics
  • Plastic Surgery
  • Psychiatry
  • Pulmonology
  • Polysomnography Radiation Oncology
  • Radiation Oncology
  • Thoracic Surgery
  • Urology
  • Vascular Surgery

Example

The provider community especially in the rural communities is in need of utilization review and management for determining the medical necessity of an inpatient admission,  reviewing and enforcing the criteria for Medicare’s two-Midnight rule, and reviewing guidelines for inpatient versus observation.

Provider organizations including rural hospitals, large rural delivery networks and ambulatory surgery centers, reach out to SFUR to provide this utilization review because they are not able to source this function internally at a reasonable rate.