Physician ServicesPhysician Chart Reviews - DRG Validation Clinical Chart Review & Validation - DRG Validation SFUR offers predictive software that list those charts requiring review that have the highest probability of documentation error. Once these charts are identified, our physicians review the charts, and the results generate a 4:1 gross return on investment for our hospital customers. This process address…

Physician ServicesPhysician Reads Physician Reads We employ over 600 board certified Physician Specialists who we credential to the highest URAC standards every 2 years. Our clients count on our exceptional medical knowledge, impartial reporting and timely delivery. SFUR is a proven and affordable source of 3rd party over-reads with ten years of history servicing hospitals nationwide. Summary If you are…

Utilization Review - InsurancePeer Review - Retrospective Retrospective Peer Review - involves the review of medical records after medical treatment has occurred. SFUR physician panelists assist health plans utilizing the health plan evidence-based criteria for delegated and non-delegated initial reviews, telephonic peer consultations, appeals for pre-service, concurrent Utilization Reviews and post-service requests for authorization of services, with the objective getting…

Utilization Review - InsurancePeer Review - Telephonic Peer Review - Telephonic SFUR physician panelists assist health plans utilizing the health plan evidence-based criteria for delegated and non-delegated initial reviews, telephonic peer consultations, appeals for pre-service, concurrent Utilization Reviews and post-service requests for authorization of services, with the objective getting closure on quality and necessity of care. SFUR has been providing…

Peer Review is used to make final judgement about quality of care in many quality assurance activities. To overcome the low reliability of Peer Review, input from several reviewers is often recommended to point out overlooked information or allow for reconsideration of opinions and thus improve reliability.
SFUR is a proven and affordable source of 3rd party medical Peer Reviews with fifteen years of history servicing hospitals, healthcare delivery systems and physicians nationwide. SFUR’s Board certified specialists will testify at fair hearing on request. SFUR is URAC Accredited Independent Review Organization which means client benefits from standards.

Even though payers deploy strategies to control physician office and hospital services, hospitals utilize utilization review and management to ensure the optimum use of the facility’s resources and high-quality care.
As value-based reimbursement models become more prevalent, hospital utilization management will take on a more important role. 
SFUR provides prospective, concurrent, and retrospective utilization review in the provider community.

Utilization Review manages medical aspects of claims in conjunction with ensuring injured workers are provided with timely and appropriate medical care. Over utilization of medical treatment is a driving factor in the overall cost of a Workers’ Compensation claim. SFUR, through the use of licensed nurses, board certified physicians and application of data driven evidence-based guidelines, addresses costs through a proactive approach.

Pre Authorization – Utilization Management covers 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 provide Utilization Review for Medicare Advantage plans and Medicaid plans.

Compliance, Fraud, Waste & AbuseExpert Medical Witness Expert Medical Witness SFUR’s 600 plus physician panel provides an excellent source of physician specialists to pull from to service the Expert Medical Witness market place. SFUR’s physician panelists have provide expert medical witness services to many of the nation’s largest health and insurance companies. Over SFUR’s 30 plus year history, thousands of…

Medical Cost ContainmentMedicare Secondary Payer Services (MSPS) Medicare Secondary Payer Services (MSPS) Centers for Medicare and Medicaid Services (CMS) maintains guidelines for Medicare Set Aside (MSA) Workers’ Comp and Liability including updates, submissions, medical cost projections (MCP), life care plans, MCP to MSA conversion, Conditional Payment Identification, Conditional Payment Dispute/Resolution, Final Document Submission, Medicaid Services, Medicaid Dispute/Negotiation, Medicare Check. Social…