Products and Services
Case Review Services:
IMEDECS Case Reviews, performed by physician specialists, combine an evidence-based evaluation of the treatment plan in question with an expert opinion to address questions of experimental/investigational status, medical necessity and medical appropriateness. [More information]
Quality of Care Reviews:
IMEDECS’ quality of care reviews – most often referred to as peer reviews – help you address and/or prevent medical errors as well as unintended outcomes by assessing the quality of care that medical practitioners are providing. The review should be used as a tool to identify issues related to documentation, decision-making, management, and technique. Quality of care reviews can be used proactively as part of annual performance evaluations, retroactively to address sentinel events, or as part of an investigative process.
Medical Coverage Policy Evaluations:
The Medical Coverage Policy Evaluation (MCPE) is an invaluable tool for health plans and managed care organizations. During policy development or update, IMEDECS conducts a thorough review of coverage criteria/policy used to approve or deny healthcare services. Physicians with expertise in providing the treatment at issue evaluate the policy against scientific literature and current practice guidelines to provide recommendations of additional indications, limitations or exclusions to the policy.
Coding reviews/ DRG validation/ Claims analysis:
IMEDECS provides expert claims analysis; comprehensive coding review and DRG validation services to help maximize your healthcare billing or assess over/under-billing and compliance. Our highly qualified and experienced staff provide assistance through strategic cost containment and a comprehensive claims review approach, which utilizes the expertise of physicians, attorneys and Certified Professional Coders (CPCs). IMEDECS reviews clinical, billing, and reimbursement documentation as well as nationally accepted and payor-specific standards and regulations in making determinations.
IMEDECS disability reviews provide disability claims managers and employers the opportunity to improve the quality of their claim decisions. Each review is performed by a specialty matched board certified physician that is engaged in active practice. The reviews can assess the source of the illness or injury, evaluate the appropriateness of the course of treatment and return to work potential; ensuring you reach the correct decision and that claimants receive the benefits they are entitled to. By utilizing IMEDECS for your disability reviews, you will receive an accurate decision in the timeframe you require.
Dispute Resolution Services
IMEDECS conducts dispute resolution services to resolve payment and billing disputes between payers and providers. Utilizing specialty matched reviewers, including physicians and Certified Professional Coders, these reviews helps clients avoid litigation and arbitration.