Case Review Services, Quality of Care Reviews, Medical Coverage Policy Evaluations, Billing Dispute Reviews, Compliance Consulting Services, Coding Reviews

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 flesh out 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. [More information]

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. [More information]

Billing Dispute Reviews:

IMEDECS is the independent Billing Dispute External Review Board (BDERB) under settlement agreements between the plaintiff physicians and medical societies and several health plans. Under the settlement agreements, the health plans have established an independent review process for disputes with physicians over application of the companies' coding and payment methodologies. In association with our strategic partner, Millennium Healthcare, IMEDECS handles appeals from physicians regarding disputes over payment for specific CPT© codes, modifiers, and code combinations. [More information]

Compliance Consulting Services:

With regulatory bodies imposing increasingly stringent standards, compliance in the health care industry has never been more crucial. In response to this, health care payors and providers must implement new compliance initiatives to improve and strengthen their internal operations. In an effort to help these organizations, IMEDECS has created compliance services to support these needs. [More information]

Coding Reviews:

IMEDECS provides coding review services for health care providers and managed care organizations. Using Certified Professional Coders (CPCs) trained in a variety of disciplines and with medical specialty expertise, as appropriate, we can help you maximize your health care billing or assess over-billing. IMEDECS reviews clinical, billing, and reimbursement documentation as well as nationally accepted and payor-specific standards in making determinations. [More information]