Medical Care Review: Keeping tabs on the treatment process

Some cases are more involved than others, and sometimes it becomes necessary to re-evaluate treatment decisions. ICS offers a full suite of medical care review services to cover any such eventuality.

Nurse Case Management

Our nurse review teams have the experience and expertise to perform thorough evaluations at any stage in the care process:

  • Prospective/Pre-certification Review — Medical services requiring pre-certification are reviewed by our nurses to evaluate and support treatment and testing decisions.
  • Concurrent Review — When called for, we’ll initiate a review to monitor the clinical status of a case as it’s happening, and to discuss or change a treatment course accordingly. The goal of such a concurrent review is achieve the best possible medical result while managing the financial resources of the insurance carrier.
  • Retrospective Review — Sometimes, when a treatment has been completed and a bill presented, our nurses will be called on to review services for appropriateness and medical necessity, and to match treatments to pre-certification information.

Physician Advisory Reviews

When needed, ICS can arrange for Physician Advisory Reviews that can occur at any stage in treatment — pre-certification, concurrent, and/or retrospective.

Independent Medical Examination (IME)

When a prospective treatment recommendation is in question, ICS refers the case to a board-certified physician in the same specialty. The goal of the IME is to assess the patient’s ability to work, determine the relatedness of injury to accident, and adjust the treatment recommendation accordingly.

We have nationwide access to provider networks fully credentialed to perform IMEs, and we draw on them regularly.

Independent Peer Review

In some cases, the need may arise for peer review within the medical specialty being utilized. Peer reviews are typically used when the medical necessity of diagnostic testing is called into question.