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Healthcare MSO Services
(Management Services Organization)

Save time and money by alleviating the burdens associated with the management side of your practice.
Click on a service below for more information:

Credential and Contracting Services

UR HEALTH manages the process of determining participation privilege status in the health plan. We do this by obtaining and reviewing documentation provided by the
applicant or obtained during the process, which may include the applicant’s education,
clinical privileges, accreditation, certifications, professional liability insurance, malpractice history and professional competence.
To become credentialed for the  rst time, you will provide:

  • Requested info
  • Attestation, signature and date
  • Curriculum Vitae, including work history in a month/year format
  • Copy of DEA and/or CDS Certificate
  • Copy of malpractice insurance face sheet
  • Summary of pending or settled malpractice cases.
Collect More and faster, Spend less, Minimize your Liability.
(305) 274-5319

Medical Auditing Department HEDIS Services

The Healthcare Efectiveness Data and Information Set (HEDIS®)
Used by 90% of health plans in the U.S.

It ensures health plans are offering quality preventive care and services to members,
and consists of a set of performance measures used by more than 90 percent of U.S.
health plans.


Is mandatory
HEDIS ® annual reporting is mandated by all regulatory agencies. As such, it is extremely
important that providers and their staff members become familiar with HEDIS® to
understand what health plans are required to report.


How does it work?
To ensure the validity of HEDIS results, all data are rigorously audited by certified NCQA
approved auditors using a process developed by NCQA, which has expanded the size
and scope of HEDIS to include measures for physicians, PPOs and other organizations.
Data is collected via HEDIS Data Submission (HOQ and IDSS) System.
HEDIS® data collection begins with claims/encounter data. If the encounter data does
not include evidence of the required performance measures during the specified time
period, the plan clinical staff must review the member’s medical record to determine if
care was provided. Claims/encounter data are the most efficient method to report
HEDIS® measures, which help ensure medical chart reviews and reviewer visits to
providers, are kept to a minimum.

Code accuracy determines proper payment
It is of the upmost importance that providers submit accurately coded
claims/encounters data for each service provided. In order to guarantee that we collect
properly coded administrative data, we have developed a tool to assist our providers
correctly code services rendered.
HEDIS® is a registered trademark of the National committee for Quality Assurance
(NCQA).

Collect More and faster, Spend less, Minimize your Liability.
(305) 274-5319

Healthcare Patient Care Coordination Services

Anticipation: key to patient’s care and safety.
We organize and coordinate all patient care activities and share the information between all of the parties involved with a patient’s care, to ensure effective and safe care. We make sure that a patient’s requirements are known ahead of time to the corresponding
people.

The UR HEALTH approach:

  • Team coordination to improve access and quality of care for patients at any of the
    health centers
  • Efficient methods of communication, including daily hospitalization reports
  • Ensure follow-up of patients after hospitalization
  • Quality control in patients care, of all age groups and stages of development
  • Prepare, special reports and analyzes, upon request
  • Track, monitor, and actively manage assigned patient cases to ensure coordination of care, retention of patient and a high level of utilization
  • Retrieve all elements to build a patient’s longitudinal care record
  • Interact with patient’s physicians and other staff both within the clinic and outside facilities providing accurate, timely and responsive information.
Collect More and faster, Spend less, Minimize your Liability.
(305) 274-5319
Chart showing MRA Medical Risk Adjustment Services

Medical Auditing Department MRA Medical Risk Adjustment Services

Why measuring and reporting on health care quality?

It gives consumers and employers the basis to make informed choices and pursue the
best available care. It also gives feedback to health plans, medical groups and doctors
that they can use to improve quality issues.

How is it done?
Surveys (on-and off-site), audits, satisfaction surveys, and clinical performance
measurement, and more. We use these approaches in a range of accreditation,
certification, recognition and performance measurement plans for different types of
organizations, medical groups and even individual physicians.

How do we ensure compliance?
Through these strategies, we are able to gather the quality information we make
available to consumers, employers, health plans and doctors, and:
• Ensure compliance with applicable regulations related to coding and
documentation guidelines for Risk Adjustment (Federal, State, and County laws).
• Review medical records, patient medical history and physical exams, physician
orders, progress notes, consultations reports, diagnostic reports, operative and
pathology reports, and discharge summaries in orders to verify whether:
– The diagnosis codes are supported by the documentation and ensure with ICD –
10 – CM Guidelines for Coding and Reporting.
– The diagnosis codes for each chronic or major medical condition have been
captured and submitted within the permitted timeframe.
Any diagnosis code is unsubstantiated by the record and should be eliminated.
Review for clinical indicators and query providers to capture the severity of illness of the
patient.

How do we ensure reimbursement?
UR HEALTH ensures consistent physician and facility reimbursement by automatically
evaluating provider claims in accordance with accepted industry coding standards
thanks to a comprehensive national recognized code auditing system to ensure
consistent physician and facility reimbursement. We constantly enhance and update
our code-editing technology to better enforce existing payment guidelines.

Claims will be reviewed to:
Reinforce compliance with standard code edits and rules.
– Ensure correct coding and billing practices are being followed.
– Determine the appropriate relationship between thousands of medical, surgical,
radiology, laboratory, pathology and anesthesia codes.
– Ensure compliance with industry standards.
Correct coding guidelines are established by:
– The Centers for Medicare and Medicaid Services (CMS).
– The American Medical Association (AMA) CPT Coding Guidelines.
– National and Local Coverage Determinations (NCD/LCDs).
– National specialty and academy guidelines.

Collect More and faster, Spend less, Minimize your Liability.
(305) 274-5319
Health Care Patient Care Pharmacy Management Services in Miami Florida

Health Care Patient Care Pharmacy Management Services

Let UR HEALTH manage your practice pharmacy needs, to ensure effective compliance and safety.

Our comprehensive pharmacy management service includes:

  • Organizing and reviewing pharmacy policies and procedures in every medical office
  • Establishing satisfactory methods of drug prescription and control
  • Establishing quality specifications for all drugs and chemicals used by PCP in accordance
    with the recommendations of the Pharmacy and Therapeutics Committee of
    CMS
  • Explaining policies and procedures in Pharmacy, department objectives, operations,
    services, and organization
  • Record keeping, assuring quality, quantity and timeliness of work done. Reviewing
    and appraising work of others within the department.
  • Preparing reports and special studies; participating and contributing to management
    and professional committees at all level inside and outside of the medical
    center.
  • Reporting on trends to assigned functions and changes insides and outside the
    medical center.
  • Maintaining care competency as indicated by orientation guidelines for a particular
    unit, for patients of all age and stages
  • Establishing notification procedures for drug interactions and high-risk medications
    for the geriatric patient.
Collect More and faster, Spend less, Minimize your Liability.
(305) 274-5319