The hospital notification process remains the key element in screening for medical treatment and diagnoses that may indicate a need for the implementation of case/disease management services, as well as to monitor the appropriateness of extended inpatient stays. Our expertise lies in the ability to identify appropriate options early in the disease process that assists with cost containment, without compromising quality care. CMS’s experienced clinicians focus on eliminating inappropriate health care services to improve clinical and financial outcomes.

CMS Utilization Review:

  • Senior Couple In Hospital RoomProvides preadmission recommendations for medically appropriate care based on clinical best practices.
  • Provides the insured, hospital representative, physician or family member a quick and easy notification process.
  • Monitors extended medical and behavioral health inpatient stays for medical necessity.
  • Identifies and implements case management or disease management prescreen services as part of our early intervention program.
  • Coordinates access to specialists for complex cases that are outliers to evidence based criteria.
  • Utilizes Milliman Care Guidelines for inpatient medical and surgical hospitalizations.
  • Coordinates discharge planning and community services for cost effective medical care options.
  • Utilizes a network of over 200 specialty physicians for clinical determinations.