AllMed Healthcare Releases its Autumn 2004 Edition of Medical Review News

October 27, 2004 — AllMed Healthcare, an Independent Review Organization (IRO), providing doctor, physician, nurse, and hospital peer review services, has released its Autumn 2004 Medical Review News.

The newsletter contains the following peer review articles of interest to Claims Managers, Claims Administrators, and Medical Directors at Health Plans, Third Party Administrators, Utilization Review Companies, and Medical Management Companies.

Outlines of the peer newsletter articles appear below. Click on the following link to subscribe to the AllMed Newsletter: http://www.allmedmd.com/newsletter/0409/press/index.htm.

Article #1—Eyelid Surgery (Blepharoplasty) Peer Review

When is it medically necessary to have Blepharoplasty?
What red flags should a case manager / claims administrator be aware of when it comes to Blepharoplasty?
How does an Independent Review Organization help in the review process for questionable cases of Blepharoplasty?
What are the top questions a claims manager should ask its Independent Review Organization when making claims decisions on Blepharoplasty?

Article#2— Hospital Stay Claim Peer Review

What is the impact of the last day of a hospital stay as it relates to medical claims administration?
When does it make sense for a claims manager to challenge the coverage for the last day’s stay?
What other options does an insurance company have to help reduce hospital stay costs?
How can an Independent Review Organization help with these cost reductions?

Article#3—Regulatory Review (Peer Review)

Under ERISA and DOL, when is an insurance company or healthcare payer required to send out a case for medical review by an external review organization?
Why must this be an arms-length medical review?
How do these regulations affect your organization?
How can an Independent Review Organization help expedite the claims review process?

AllMed provides peer review opinions that quickly resolve complex problems — saving money while protecting the integrity of patient care. AllMed will review chart notes and operative reports to render objective written opinions; help you reach the right decision while reducing legal risk; apply your plan language to the case, if appropriate, give you direct access to our physicians for questions and follow-up on peer reviews; and supply clear, professional and easy-to-read documentation. AllMed also applies the same high quality standards to its medical review, pharmacy review, medical bill auditing, and medical director review services.

More information on AllMed and the company’s peer review & medical review services can be found on AllMed’s web site at http://www.allmedmd.com/ .

About AllMed Healthcare Management

Founded in 1995, AllMed (http://www.allmedmd.com/ ) is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed’s growing customer base includes premier organizations, such as Educator’s Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.