About South Florida Utilization Review SFUR & URAC

CREDENTIALED BY URAC STANDARDS EVERY THREE YEARS

We contract with over 200 board certified Physician Specialists who are credentialed very 3 years by South Florida Utilization Review under the comprehensive URAC certification standards.  Our clients partner with us to extend or outsource their internal quality assurance, utilization review & audits, compliance and legal proceeding.
For over 10 years South Florida Utilization Review SFUR has been certified by URAC Certification as an Independent Review Organization IRO.

About the URAC Organization

For 25 years, URAC has been the independent leader in promoting health care quality through accreditation, education, and measurement. URAC offers a wide range of quality benchmarking products that reflect the latest changes in health care and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability.

URAC History

In the late 1980′s, concerns grew over the lack of uniform standards for utilization review (UR) services. UR is the process where organizations determine whether health care is medically necessary for a patient or an insured individual. As a result, URAC’s first mission was to improve the quality and accountability of health care organizations using UR programs. In later years, URAC’s mission expanded to cover a larger range of service functions found in various health care settings, including the accreditation of integrated systems such as accountable care organizations and health plans to smaller organizations offering specialty services. Formally incorporated in 1990, URAC has more than 30 accreditation and certification programs.
From conception, URAC’s founders recognized that an accreditation organization would not be accepted by regulators, health care providers, and consumers if controlled by industry interests. Therefore, several operating principles were incorporated into URAC’s structure and bylaws. First, URAC was set up as an organization independent of any particular stakeholder group. Second, the governing board of directors was established with representatives from all affected constituencies: consumers, providers, employers, regulators, and industry experts.
URAC is one of the fastest growing health care accreditation agencies in the world. It will continue to develop new standards for the health care system and revise existing ones to promote national standards and to ensure that all stakeholders, including consumers and providers, are protected.
More information on URAC can be found on their website at www.urac.org

Fully Funded Traditional Insurance vs. Self-Funded Health Plans
Most Americans don’t know the difference between “traditional” fully funded insurance, and a self-funded benefit plan.Yet, more than 60% of people receiving health benefits from their employer are participating in a self-funded plan.When an employer pays a premium – a fixed amount – to an insurance carrier, and the insurance carrier pays more (if insured individuals are sick or hurt) or pays less (if insured individuals are healthy), that is “traditional” fully funded insurance.With “traditional” fully funded insurance, individuals and employers pay a fixed premium to an insurance carrier, and the carrier takes on the risk. With a self-funded health plan, an employer sets aside some of its funds to pay for employees’ medical expenses. Employees then contribute to the plan rather than pay traditional premiums …

Executive Summary
The property-casualty insurance industry is likely to become the target of significant additional cost-shifting by hospitals, physicians, and other medical providers responding to the cost-containment provisions of the Patient Protection and Affordable Care Act (ACA). The ACA dramatically alters healthcare markets and health insurance systems in the United States. Although the property-casualty insurance industry is not directly included or targeted by the act, it is not entirely immune to its effect ….

How carriers and adjusters respond to property losses can reduce the impact of the claims as well as the costs, according to Lynne Jurek Shannon and Doris T. Bobadilla, defense attorneys with the Galloway, Johnson, Tompkins, Burr & Smith law firm.  Both said the strategies for cost containment on property damage claims remain the same across the country.   Adjusters no matter where in the country they are can work by the same rules and use the same types of tips in order to accurately and as inexpensively as possible handle their claims,” said Shannon. “The types of claims are the same and the objectives of cost containment are the same.”   The attorneys reported that nearly 73 cents of each premium property casualty dollar goes to staffing, investigation, defense and resolution of claims. Evaluating expense costs alone won’t reduce this figure; rather, a careful examination of the claim will, the attorneys said.

Cheaper Doesn’t Equal Better …