SFUR provides medical utilization professional services, applying medical practice and financial knowledge to improve our customers’ process, outcomes and financial results.
We service healthcare organizations across the country including physicians, physician practices, surgical centers, nursing homes, skilled nursing facilities, rehabilitation facilities, ancillary centers such diagnostic laboratories and imaging centers, hospitals, healthcare delivery systems and accountable care organizations.
Our URAC certified review services are provided through our physician panel of over 600 highest quality of practicing Physician Reviewers. Our medical experts span all medical specialties throughout the country.
SFUR offers predictive software (through one of our trading partners) that list those charts requiring review that have the highest probability of documentation error. Once these charts our identified, our physicians review the charts, and the results generate a 4:1 gross return on investment for our hospital customers.
Insurance Utilization Review
The medical Utilization Review/Utilization Management (UR/UM) component for Medicare Advantage, Managed Medicaid and other managed care plans is a critical function that requires medical depth, breadth and resourcefulness. Members of SFUR’s physician panel have been providing Utilization Review for Medicare Advantage plans in thirty-two states for over ten years.
Compliance Fraud Waste Abuse
SFUR is committed to improving the healthcare ecosystem. Both healthcare delivery participants and those entities that pay for healthcare, leverage the knowledge of the SFUR’s physician panelists. Monitoring compliance, fraud, waste and abuse starts with the SFUR physician panelists that can be impartial, objective and current in the knowledge and practice of their respective specialty.
Medical Cost Containment
SFUR defines medical cost containment as the process of leveraging medical and business knowledge to potentially lower the cost of medical bills.
We provide review, assessment and negotiation of medical cost, using a variety of methods which include, Separation of Charges, Coding Validation, Medical Necessity, State & Payer Specific Rules and Reasonable Charge Analysis.