Our reviews evaluate the complete medical record to validate the medical necessity for providing a specific service. Additionally, we assess the documentation to determine the appropriate site of service (inpatient vs. outpatient) for the procedures performed. Facilities may request reviews to evaluate individual physicians with a comparison to their peers. These reviews are often prompted by the OIG work plan and are the current focus of RAC audits.
ZHealth offers three types of medical necessity reviews: Procedure Medical Necessity, Inpatient Medical Necessity, and Medical Necessity based on Imaging Studies. Deliverables include a comprehensive report with a formal presentation of findings and recommendations by a ZHealth physician on-site or by phone.