The Initial MD Review product is designed to provide an inexpensive and succinct opinion to help during your early decision making process, as though from an internal Medical Director on staff at your office. These reviews are an excellent resource for clients with limited or no access to on-staff Medical Directors.
Initial MD reviews are intended to provide brief, concise opinions on medical necessity for services such as Inpatient Stay, Skilled Nursing, Mental Health, Rehabilitative Therapy, Radiology services to include MRI, Ultrasound, CT Scans, etc., and many more services.
MRIoA utilizes Family Practice and Internal Medicine Physicians from our panel of reviewers to provide an opinion to help you determine medical necessity or determine coverage of services based on specific criteria or guidelines submitted. Complex cases, coding cases, or cases that require literature research and/or discussion, or require the expertise of a specialist, are not appropriate for this service. If a review request is for a service out of scope for these reviewers, or is for a service that is not eligible for the Initial MD Review product, MRIoA will contact you for direction.
Utilization of this service will allow decisions to approve, when appropriate, before a service is formally denied. The Initial MD review is not considered to be an “Initial Peer Review” as defined by URAC or NCQA. Rather, it is a helpful resource to be utilized prior to a denial, or to confirm your internal decision that a case should be approved.
This product is Smart, Simple, Streamlined, completed with Speed and Security, resulting in Savings. If you are interested in using this service as a resource, please contact your Marketing Representative for details.
Valerie Ottman, CPC, CPC-H
Director of Quality Management
Quality Management Coordinator