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THE
PROBLEM -
Too many times the management of chiropractic utilization
has been an after thought. Plans with their primary focus on medical
/ surgical management ignored chiropractic services through oversight,
through reasoning that they would resolve that issue later andperhaps
through hoping it would just go away in time. But time passed and chiropractic
didn't go away, later came without a satisfactory resolution, and the
plan was left with a growing set of chiropractic related problems.
THE
SOLUTION -
Fortunately the multitude of management problems associated
with chiropractic utilization review have a single resolution. PRN.
PRN
software was designed with the end in mind. It was built from experience,
from trial, error and hindsight to be a comprehensive
review solution that ties together the issues of:
- Utilization
Review
- Provider
Credentialing and Re-Credentialing
- Quality
Assurance
- Provider
Communications
- Provider
Development
- Plan
Management
- Cost
Containment
The
PRN system was conceived and constructed by practicing chiropractors
based on two foundational principles:
Principle
One- The largest percentage of chiropractors report honestly and
treat patients effectively. These doctors need no management and time
spent on the UR of their cases is money wasted. The ideal UR system
would function to standards that would be essentially unfelt by these
providers. They would find reporting and compliance with plan standards
to be effortless and without issue.
Principle
Two- A small percentage of chiropractors do not report honestly
or are not able to treat patients effectively. Though small in numbers,
they represent the greatest percentage losses to plans. No amount of
time spent on the UR of their cases will alter their character or increase
their abilities, but it will save money. The ideal UR system would function
to standards that would constrain and discourage participation by these
providers.
THE
NET EFFECT OF PRN -
The PRN system was designed to encourage proper chiropractic
care. It is almost invisible in its management to the majority of chiropractors
who are providing quality care, doctors whose care never needed third
party managing. At the same time PRN was designed to identify and constrain
improper chiropractic care and to consistently identify the chiropractors
who "are the problem" for which managed care exists.
PRN
Facts and Functions
Why
Use Professional Review Network Software?
Because we make the Utilization Review of Chiropractic Care...
FAST
Our software will approve Clinically Reasonable Chiropractic Care INSTANTLY!
The treating doctor spends one third of the time that paper forms require
to complete. Patients are delighted to have their care approved the
same day they are first seen! Third party payers spend NO TIME in reviewing
treatment plans that fall within clinically reasonable standards! Those
plans that fall outside of standards are automatically delivered into
clinical reviewers mailboxes through the Internet. This allows third
party payers to use the ideal consulting reviewers, not just the ones
that are close enough to commute to their office.
CONSISTENTLY
FAIR
The clinical rationale behind the decisions of third party payers and
their consultants are subject to increasing scrutiny, costly appeals
and even litigations. PRN software provides authorizations for care
that are consistent, well accepted, defensible, 100% reproducible and
developed through a consensus of practicing chiropractors. Third party
payers can set the standards and modify the parameters of the PRN software
to optimize results for their plan parameters.
LEAST
EXPENSIVE
If 50-80% of the chiropractic treatment plans your company must now
review manually were handled automatically, without any staff time,
how much money would that save your company? PRN can do that. In fact,
it seems that it is much harder to justify to the boss why one did not
choose to save this much of the company's money on an on going basis
than it is to justify the small cost of our software purchase.
SIMPLE
TO MANAGE
Imagine all the treatment plans ever filed for a patient organized into
chronological order in a chart with all the critical data in fast
to read columns allowing for an instant overview of a patient's
case. Now imagine that instead of the usual file room hassle and wasted
money involved in accessing and reviewing past treatment plans, that
all you had to do was click your mouse on any of the treatment plans
in the chart to have that treatment plan in front of you instantly.
Could it get any simpler? PRN does that.
For
more detailed information on PRN utilization management software or
for access to the system demo contact:
Dr. Glen Nykwest at: 914-273-5505
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