http://www.allmedmd.com daily 1 2008-10-14T21:12:17Z http://www.allmedmd.com/resources/for-healthcare-payers/articles-1/identifying-and-reducing-overutilization-of-epidural-steroid-injections Criteria-based decision making regarding the use of epidural steroid injections (ESIs) plays a critical role in not only determining the proper authorization and coverage of these services, but also in ensuring that qualified patients receive the appropriate number of treatments. Millions of dollars are spent each year on initial injections that are medically unnecessary, and on the administration of repeat injections despite the failure of a first series of ESIs to provide significant, persistent pain relief. Improper reimbursement of ESIs results not only from improper medical utilization, but also from the inadequate documentation of either the diagnostic findings or the measures associated with pain relief. No publisher swolverton payer internal article article newsletter epidural injection 2010-09-09T21:46:10Z Article http://www.allmedmd.com/resources/for-healthcare-payers/articles-1/manage-costs-and-reduce-patient-harm-with-consistent-brca-testing Adhering to the National Comprehensive Cancer Network guidelines regarding the testing of BRCA mutations can reduce cancer risk and improve survival rates. In addition, payer organizations can better regulate the costs of these expensive genetic tests. No publisher swolverton medical necessity cancer payer genetic testing internal article article 2010-07-06T19:41:54Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/off-label-avastin-use-for-wet-macular-degeneration-1 Researchers have determined that off-label use of Avastin is an effective treatment for wet AMD, the leading cause of blindness in people over 50 years old. Although physicians and researchers are debating the effectiveness of Avantis versus Luncentis, a drug that costs 40 times more than Avastin, some ophthalmologists consider the two to be equal. No publisher swolverton article independent review organization payer internal article 2009-05-15T21:27:00Z Article http://www.allmedmd.com/resources/for-healthcare-payers/articles-1/lyme-disease-what2019s-the-benefit-of-antibiotic-therapy-for-long-standing-symptoms No publisher swolverton article lyme disease payer internal article 2009-04-07T22:41:39Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/battling-childhood-obesity-with-bariatric-surgery With childhood obesity becoming an ever-present epidemic, the issue of patient qualification for bariatric surgery needs to be revisited. Recent data shows that nearly 17 percent of US youth between the ages of six and 19 are considered overweight. No publisher swolverton payer bariatric surgery internal article child article obesity newsletter 2009-01-29T00:54:20Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/9-hints-telltale-signs-that-say-you-need-an-iro Using an IRO is an efficient and defensible way to manage a health plan properly for both the insurer and the patient. As unbiased advocates for managing healthcare costs, IROs ensure that every claimant is properly served, every time. Read more for nine hints and telltale signs that you need an IRO. No publisher swolverton article independent review organization payer internal article 2009-01-29T00:54:50Z Page http://www.allmedmd.com/collaboration/articles/allmed-articles-1/diagnosing-and-treating-circadian-sleep-disorders No publisher swolverton article sleep payer internal article 2009-01-28T16:13:55Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/when-renal-artery-stenosis-screening-is-medically-necessary No publisher swolverton article medical necessity payer internal article 2009-01-28T16:13:05Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/avastin-bevacizumab-therapy-in-oncology No publisher swolverton article oncology payer internal article 2009-01-28T16:12:14Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/management-and-care-of-acute-coronary-syndromes Atherothrombosis is the leading cause of death worldwide and accounts for 52 percent of all deaths. Over 55 million people worldwide died from atherothrombotic disease in 2000. In 2004, there were 1.6 million of hospitalizations for ACS, 700,000 for UA and 900,000 for myocardial infarction (MI). Of these, about 30 percent presented ST-segment elevation in the electrocardiogram (ECG). No publisher swolverton article payer internal article 2008-12-30T21:09:46Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/developmental-delay-how-to-diagnose-plan-exclusions Developmental delay is a term applied to a wide range of disorders, including mental retardation, motor delays, developmental language delays, developmental coordination disorders, autism spectrum disorders and global developmental delay. Before modern imaging and genetic studies, the term described any child not achieving developmental milestones and in whom a medical diagnosis had not been identified. No publisher swolverton medical necessity payor payer internal article article developmental delay 2008-12-30T19:38:27Z Article http://www.allmedmd.com/collaboration/articles/allmed-articles-1/when-is-eyelid-surgery-medically-necessary No publisher swolverton article medical necessity payer internal article 2008-10-15T22:03:37Z Page http://www.allmedmd.com/collaboration/articles/allmed-articles-1/what-to-consider-for-sleep-apnea-treatment Because sleep apnea can be caused by a handful of different factors, treatment options vary. Understanding the cause of the sleep apnea is the first step towards deciding the best treatment option for the patient. No publisher swolverton medical necessity payer pulmonary medicine internal article sleep treatment article obesity 2008-10-15T22:02:06Z Page http://www.allmedmd.com/collaboration/articles/allmed-articles-1/understanding-fda-approval-for-medical-devices While FDA approval for a drug product suggests safety and efficacy, the same approval for medical devices does not. Approval for a device only assumes the manufacturing method is reliable and that the device is similar to another on the market. One such device is the Vest Airway Clearance System. No publisher swolverton medical necessity payer pulmonary medicine internal article treatment article 2008-10-15T21:59:59Z Page http://www.allmedmd.com/collaboration/articles/allmed-articles-1/ten-reasons-to-use-an-independent-review Increasingly, healthcare providers, insurers, medical directors and case managers are turning to Independent Review Organizations (IROs) to collaborate on the decision-making process for medical claims. At question, however, is when in the decision-making process does this make the most sense? Here are the top 10 signs to identify when to bring in an IRO: No publisher swolverton article independent review organization payer internal article 2008-10-15T21:59:21Z Page