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Physician Profiling makes radiology management more effective by improving imaging utilization awareness. MedSolutions has gained a unique expertise in physician profiling and analysis through the years of our intense focus on radiology. Our Physician Profiling and claims analysis can give you a clear picture of your radiology utilization environment. Profiling reports are critical in communicating with referring physicians and radiologists, and play a key role in targeted physician education. It also allows us to recognize network trends as they develop, and intervene with customized management techniques before they're out of control. Every quarter, you will receive complete reports detailing each provider’s utilization compared to total healthplan utilization and national benchmarks. These reports serve as a ‘report card’ to reveal outliers for targeted physician education. We conduct targeted meetings between MedSolutions' Chief Medical Officer and individual referring physicians to address issues and concerns in a partnership approach. Our goal is to bring them in line with normal utilization and national benchmarks. The Process Diagnostic imaging utilization is analyzed and tracked through both the pre-certification system and imaging claims database. The pre-certification data permit “real-time” analysis of imaging utilization since data are collected daily while claims data typically reflect a lag of a least a quarter and up to two quarters depending on the client. The pre-certification system collects information such as member ID, CPT code, ICD-9 code, referring physician and authorization status. These variables permit the analysis of referral patterns and volume. Data can be linked to supporting files such as eligibility and provider data to conduct further analysis by region, risk group, PCP or other parameters of interest.
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Us || Why Radiology Management?
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