Should Providers Use Utilization Management Software?

What is Utilization Management?

Utilization management, otherwise known as utilization review, is the process of figuring out if a health care service, procedure, or facility is medically necessary, appropriate, and effective based on the rules of the health benefits plan. It ultimately involves examining healthcare benefits to control and regulate healthcare costs for patients. Improving utilization management means that the members get the care they need without irrelevant testing, unnecessary spending, and excessive services that they don’t need. 

The Importance of Utilization Management Software to Healthcare Systems

Utilization management software helps organizations pin down the waste in the healthcare system and deliver quality care. Providers can identify services that are not necessary by monitoring the availability of accessible resources. This includes facilities, equipment, or personnel, among many others. An organization needs to have access to relevant ratios and benchmarks in order to get the most out of its tools and infrastructure. They use these standards to ensure that they are running at peak efficiency whenever it is needed. 

Prevent unnecessary costs

Hospitals and other healthcare providers are prone to overspend on services. With utilization management software, physicians and care teams in charge can view and generate detailed reports on how much money they use for each service. This can push them to make better and smarter decisions for each patient.

Follow compliance regulations

Utilization management software has become the best way for hospital managers to keep track of patient information. It aids with compliance management by providing patients with access to their medical records, by providing healthcare providers with real-time data, and by offering automated reporting and analytics.

Reduce claim denials

Claim denials come in the form of a request for additional information. It is common for denied claims to go back and forth between the provider and the payer due to a lack of documentation. Utilization management software can help document case notes, which can ultimately lead to fewer claim denials.

Leverage Care Management Resources

Utilization management software helps you in  expediting claim processes. It enables organizations to ensure there is no gap between the medical treatments that clients receive and the bill that the insurance company gets for the given services. It also determines the best way to allocate resources, allowing physicians to provide care to patients who need it the most and enabling organizations to:

• increase revenue through cost-effective patient care;
• improve bottom line by reducing under-utilized healthcare services;
• ensure optimal staffing levels by identifying available capacity and comparing it to the number of patients that require care; and
• understand and improve the utilization of your healthcare system.

Utilization management software is the digital backbone of healthcare providers aiming to improve patient care outcomes. It is an important tool to measure and analyze performance to review the appropriateness and costs of the associated care. Luckily, MedVision’s QuickCap v7 (QC7) offers the most comprehensive administrative platform that lets you easily reduce the number of unnecessary tests and procedures. Look for opportunities to identify areas of improvement and make the right changes for your organization with a healthcare solution like QuickCap.

Optimize Healthcare Utilization With Ease Today!



Reference:

Healthcare Revenue Cycle Management. “Hospital Utilization Management Can Reduce Denials, Improve Care.” Accessed October 17, 2022. https://revcycleintelligence.com/features/hospital-utilization-management-can-reduce-denials-improve-care.