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Improving Utilization Review Outcomes By Way of Integrated Outcome Measures

  • Mission Inn and Spa 3649 Mission Inn Avenue Riverside, CA, 92501 United States (map)

Join Elizabeth Irias, LMFT and Robert Scholz, LPCC, LMFT at this year’s C-Suite in Riverside, co-sponsored by Clearly Clinical, for an engaging discussion about how truly integrated outcome measures can improve UR processes.

Length of Presentation: 60 minutes

Description: As scrutiny from commercial insurers continues to heighten, collecting reimbursement from insurance providers remains a daunting and complicated pursuit. Both the administrative and clinical sides of the business must be aligned in prioritizing the quality of patient care to improve clinical outcomes and capture the insurance reimbursement necessary to keep the doors open. Medical necessity drives the revenue cycle, yet sub-par documentation, outcome measures, and medical records continue to present a huge challenge for most providers, often resulting in significant financial losses.

Utilization Review guru Elizabeth Irias, LMFT, and clinical systems expert Robert Scholz, LPCC, LMFT have collaborated to present solutions for prioritizing patient care by way of outcomes measures like Feedback Informed Treatment (FIT) while improving Utilization Review outcomes. FIT is a collaborative and deliberate approach for evaluating and improving the efficacy of therapeutic services, and research shows that programs utilizing FIT strategies are able to more effectively keep clients in treatment, improve their treatment outcomes, and identify earlier those clients whose symptoms are worsening, while simultaneously working toward the satisfaction of requirements issued by accrediting bodies like The Joint Commission. Attendees can expect to gain insight into how clinical documentation and integrated outcome measures directly impact the entire revenue cycle, from the front-line initial authorization requests to the bitter end in appeals via medical record reviews. Best practice strategies for protecting the long-term health of your business by appropriately integrating outcome measures will be discussed alongside first-hand experience from these treatment providers on the practical application of these concepts.

Objectives: Upon completion of this course, participants will be able to:
- Provide one or more definitions for the term Medical Necessity
- List two or more research findings that support the use of routine monitoring of the therapeutic alliance and outcomes
- Describe how outcome measures contribute to the establishment of Medical Necessity in relation to Utilization Review

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