UTILIZATION MANAGEMENT
Todays
health care system is extremely complex. Medical services
can be fragmented and excessive. Provider pricing may
vary from area to area, even within the same city. Practice
patterns may vary from doctor to doctor. It can be difficult,
if not impossible, to determine whether a prescribed
treatment plan is really the "right" solution
to a specific illness or injury.
We don't believe in rationing care, but we do believe
that utilization management should eliminate unnecessary
procedures, shorten hospital stays, and enhance the
delivery of health care. Managed care doesn't mean withholding
care, it means providing appropriate care – making
sure that the diagnosis is as accurate as possible and
that the care received is in the proper amount and in
the appropriate setting.
SERVICES
- Precertification
for all inpatient stays and outpatient surgery
- Preauthorization
for inpatient initial lengths of stay
- On-site
concurrent review
- Discharge
planning initiated upon inpatient admission
- Concurrent
telephone review for all out-of-area inpatient admission
- Case
management on as as-need basis
- Retrospective
review on all admissions not pre-approved
- Refferal
to the Medical Director for physician-to-physician
interaction on all inappropriate lengths of stay and
level of care. Denials issued by the Medical Director
as necessary. All denials are eligible for reconsideration
via the MCC Health Care appeals process.
LARGE
CASE MANAGEMENT
Large Case Management is used to coordinate complex
medical care. The focus is on the population with catastrophic
conditions that consume health services dollars. Case
management is a collaborative effort which assess, plans,
implements, coordinates, monitors and evaluates the
options and service to meet the individual’s health
care needs using community resources available to provide
quality and cost effective outcomes. All work is coordinated
to achieve agreed upon goals for the patient.
ON-SITE
REVIEW
Unlike many medical management programs, MCC does not
focus solely on managing inpatient care. Our success
at controling cost and assuring quality is achieved
through on-site management. Programs monitor each component
of care, including inpatient procedures, outpatient
procedures, perscription drugs, specialist care, home
health care, and long-term or catastrophic care. In
each and every case, MCC staff reviews and assess care
- from pre-admission through discharge and home care,
as necessary.
PHILOSOPHY
The quality of medical care and the effective coordination
of medical treatment is an integral part of the program.
MCC, Inc. believes in making sure that the diagnosis
is as accurate as possible and that the care received
is in the proper amount and in the appropriate setting.
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