Acumentra Health offers utilization management (UM) and quality review services in acute care, ambulatory/outpatient care, long-term care, home health, and mental health settings.
Utilization management and review may examine
Acumentra Health’s reviewers conduct medical record case review to determine whether the care received was medically necessary and appropriate. Reviews may include utilization, coding, or quality of care issues.
Health care professionals review, assess, and evaluate patient care processes to ensure that a practitioner provides appropriate care. Our qualified health care professionals include
Peer review, an in-depth review of provider medical records as follow-up to a case review, is an important component of the quality-of-care oversight. The reviewer is generally from the same specialty as the provider that delivered the care in question.
Acumentra Health provides prior authorization review—an assessment of medical necessity, appropriateness, and level of care before a patient is hospitalized or an outpatient procedure is performed. Acumentra Health issues certificates of need for services for children and adolescents, authorizing services prior to admission to psychiatric residential treatment.
Concurrent reviews provide information on care presently being provided and can help to determine future care needs. Acumentra Health has conducted concurrent review since 1984.
Acumentra Health also provides retrospective, or post-payment review services. Post-payment reviews examine services provided in hospitals or other settings after care has been provided, a claim for payment has been submitted, and reimbursement has been paid. These reviews examine medical necessity, appropriateness of coding, and quality of care.
Last updated March 4, 2013