MEDICAL COST CONTAINMENT PROGRAMS
All aspects of medical care are monitored and evaluated by Future Care's medical staff, including review by our staff physicians who are Board Certified in Quality Assurance/Utilization Review.
Full Service Provider Network (PPO)
- Hospitals, physicians, ancillary providers
- Screened and credentialed specifically for quality delivery of occupational medicine
- Negotiated fee schedules with substantial reductions
Pharmacy Network
- Extensive network of pharmacies for prescriptions at discounted rate
- Direct billing to prevent injured worker from paying for prescriptions
- Pharmacy card program for ongoing prescription management
- Network for durable medical equipment and supplies
PPO Repricing
- Repricing of medical bills to PPO contracted rates
Utilization Management
- Inpatient Utilization Review, Pre-admission Review, Concurrent Review, Discharge Planning
- Outpatient Utilization Review
Retrospective Review
- Bill review for reasonableness of fees
- Appropriateness of services
- Medical necessity determination
- Relatedness of services
- Exclusively provided by health care professionals experienced in utilization review and quality assurance
Case Management
- Begins at the time of injury through a highly effective, early-notification
process; coordinated by a Case Manager who is able to initiate, when appropriate:
- Vocational rehabilitation
- Independent medical evaluations
- Work hardening
- Home health care
- Following discharge, a Case Manager facilitates appropriate treatment on behalf of the patient
Bill Review
Fee Schedule/Usual & Customary
- Systematic review of all claims from providers
- Appropriate Procedure Coding (CPT-4) and Diagnostic coding (ICD-9) assessment
- Review and Repricing
Management Reporting
- Specifically tailored to comply with state and client requirements
- Future Care protects client's standing with state regulatory agencies by preparing reports in accordance with state requirements
- Custom reports available to meet individual client needs
Provider Recruiting
- National contracting
- Ongoing contracting, with an industry leading average annual increase in PPO size since June 1989
- Contracting based on client requests and medical payout information
Provider Relations
- Ongoing provider education
- Maintains stable network
- Resolution of balance bill problems—Response within 48 hours of receipt
- On-site visits to providers
Educational Support
- Staff available to provide educational seminars on Utilization Management, Bill Review, Case Management and PPO Services
- Staff available to educate and support insureds and producers