Workers' Comp

Six Questions to Ask When Evaluating a Medical Management Software Solution

June 3, 2022

The medical management software provider that you select as your partner can have a major impact on not only your organization's claims outcomes, but also the lives of the injured party. When looking for a utilization review partner, make sure to ask detailed questions before making a decision. One of the first things that you should do is evaluate the medical management software that the partner offers. The questions listed below can help you assess important features that you should be looking for in a software platform.

1. Does the software contain a repository for document and correspondence management?

Having a tool that integrates medical records and treatment history at a glance allows clinicians to make informed decisions more efficiently. Additionally, if the software also serves as your communication hub for all relevant parties working a case, then email, fax and print notifications and conversations should remain within the tool for easy access and internal audit controls. These controls are lost when outside solutions are used to support these communications.

2. Is the software fully integrated with other case management, bill review and cost containment solutions?

Disparate solutions can be costly. Lower the total cost of ownership and accelerate implementation time by asking your potential software provider if their utilization review medical management software can integrate with other systems. There are typically multiple users remotely working a utilization review and case management case; so those users should have efficient workflow processes and immediate shared access to medical documentation, case notes and evidence-based guidelines. Solutions that allow utilization review and case management parties to remain informed regarding progress and outcomes, as well as the ability to seamlessly integrate those outcomes to a bill review platform, are key capabilities.

3. What modes of communication are available to communicate with preferred suppliers?

How are phone calls and faxes tracked? For example, does the software automatically re-send failed faxes? Can the user generate email correspondence with relevant parties from within the software? Can the responses to those emails auto-postback into the software and notify the sender that a response has been received? If a fax fails to generate to a provider or attorney, can the software automatically failover to print? These are all very important aspects that a comprehensive platform should provide.

4. Can users easily customize and run reports, including reports that use real-time data to help in managing workflows, tracking performance and detecting patterns in treatment requests and determinations?

One important feature that you need to assess is whether the potential medical management software offers powerful reporting tools that help you efficiently notify parties of outcomes or progress and extract data as needed to support the analysis of your utilization review, case management programs and related workflows.

5. Are there rules, products and guideline tools embedded in the systems to support automated decision making? Is the software customizable to my company?

Ideally, your medical management software will provide you with some structure and help to standardize processes. For example, a system could include letter templates and recommended guidelines which are helpful, but make sure the provider you choose also allows for some flexibility. Your company and business needs are unique and constantly evolving. Choose a medical management software system that can fit your needs through creating custom treatment review engine rules, letter templates and workflows to take customizing user workflows a step further.

6. Does the software help my organization stay compliant?

The medical management software should allow users to create customized data fields to assist in meeting jurisdictional utilization review requirements, and tracking jurisdictional timelines. It should facilitate data capture to allow for fully compliant, automated notification letters, as well as support your utilization review quality program. Choosing a medical management software to support your utilization review and case management programs is a big decision that can impact an organization’s workflow, compliance, and outcomes. Time matters and medical decisions can impact an individual’s quality of life. It’s a good practice for utilization review companies to operate efficiently, always be in compliance and conduct all interactions with high quality. When looking for a software partner, be sure to ask detailed questions and get the right answers to help ensure that you’re finding a utilization review solution that delivers every time.

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