Medical Review
HCE has over 35 years experience in conducting medical case review to determine if services provided were reasonable and medically necessary, were provided in the most appropriate setting, met professionally recognized standards of health care, and were appropriately billed. The company is noted for its use of varied analytical and review approaches to conduct effective quality assurance reviews, utilization reviews, and medical data analysis.
Utilization Review
HCE’s utilization review program is designed to help contain health care costs, improve quality of care, and assure that health care dollars are spent on medically necessary and appropriate services. We use qualified, professional staff, appropriate criteria, practice guidelines, regulations and rules, and knowledge of prevailing standards of care in the specific state or community to make the most accurate review determinations. We have physician panels in multiple states, consisting of nearly every clinical specialty.
HCE’s Indianapolis location is URAC accredited in Health Utilization Management with full accreditation through June 2012.
Peer Review
HCE has a long tradition of Medicare and Medicaid medical peer review. As one of the original Peer Review Organizations, our company was founded on the principles of independent, objective, and clinically-based evaluation. We have an established network of credentialed physician reviewers to conduct peer-to-peer medical specialty review of cases that do not meet screening criteria applied by our nurse reviewers.
We currently offer supplemental peer review services to hospitals needing outside expertise or assistance in peer review on an individual case basis.
Quality Review
HCE is a nationally recognized and award-winning quality improvement organization. The company is best known for varied and significant quality improvement studies, high quality medical review, educational and consultative services, and for careful attention to customer service.
Coding Review
HCE is a highly strategic consulting-firm with in-depth experience in medical information management coding and compliance audits. We have highly qualified clinical and medical coder expertise available to conduct coding compliance audits.
