Every participant in healthcare—from payors and clinicians to patients and their families—benefits when imaging is ordered and performed appropriately. As healthcare moves further toward population health and bundled payment mechanisms, expertise in Utilization Management (UM) becomes more essential. RadNet has the tools that will help our partners and payors.
Here’s how we do it:
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The engine of our UM program is our Radiology Utilization Management System (RUMS), used to review imaging requests.
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Our Utilization Management department processes over 300,000 referrals annually.
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The UM staff consists of board-certified and state specific licensed radiologists, physicians, registered nurses, and licensed vocational nurses.
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Cases are reviewed for medical necessity and appropriateness according to accepted guidelines. We use nationally recognized evidence-based guidelines from multiple sources, medical literature, and consultation with subspecialty trained radiologists.
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Emphasis is placed on educating referring sources regarding medical necessity and appropriateness—not as much on accepting or denying pre-authorization requests. Our focus is on offering better alternatives in imaging, not on “gate-keeping.”
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Physicians are profiled against their peers by delivery model or by specialty.
“Our program is designed to educate when needed. Good Utilization Management is good Quality Management in medical care. Quality medical care is providing the right care at the right time—no more, no less.”