The UM landscape is evolving and health plans, medical management organizations and others must stay abreast of these changes.
Annapolis, MD (PRWEB) March 30, 2016
RegQuest™, one of the nation’s premier online regulatory compliance resources focusing on medical management and insurance functions, is pleased to announce the first in a series of webinars focusing on the evolution of utilization management (UM) programs and related medical management functions over the past three decades with a detailed overview of how UM programs are regulated and operationalized today.
“UM practices have evolved overtime based upon regulatory requirements, reform initiatives and changes to the market” notes Julie O’Brien, President of Alicare Medical Management (AMM) and featured webinar speaker. “Health plans, medical management organizations, and others must stay abreast of these changes. The UM webinar will highlight the evolving UM landscape and provide some perspective as to where UM is heading in the future.” O’Brien oversees one of the most established and well respected care management organizations in the United States. She also serves as President of the National Association of Independent Review Organizations (NAIRO).
The webinar is based in part on information released in the Utilization Management Regulatory and
Market Trends: 2016 Annual Report. “The UM Trend Report is the first update on the topic in over a decade and the research reveals several interesting trends pertaining to utilization management (UM) programs,” notes Garry Carneal, JD, MA co-Founder of RegQuest and a webinar co-speaker. “The new report confirms the valuable role that UM practices play in the delivery of medicine and the allocation of health care resources, but also sets forth a number of challenges for the future.”
The speakers will highlight:
- The impact of recent regulatory reforms on the ways that health plans make “medical necessity” and “scope of coverage” determinations;
- How the appeals process works when a “denial” of care or adverse benefit determination is made;
- Key UM regulatory requirements, including the licensure process, quality requirements, and clinical reviewer qualifications;
- Liability issues associated with the “corporate practice of medicine”; and
- How UM and care management programs are currently deployed to support integration, workflow efficiencies and improved clinical outcomes.
In addition to the UM presentation, RegQuest is offering educational webinars on mental health parity and external review regulations. To find out more about these webinars, visit http://www.regquest.com or click here to register. A Q&A session will follow each presentation, so don’t miss this opportunity to hear from national experts on the topics impacting medical management.
For more information regarding the UM Trend Report, including a complimentary six-page Executive Summary, click here. Copies of the full-length UM Trend Report are available to paid subscribers of RegQuest’s Utilization Management Module. Purchasers of the UM Module also have access to RegQuest’s comprehensive database of UM state laws and regulations, quick-reference tables and receive email alerts to any updates that impact UM stakeholders. To subscribe, please visit http://www.RegQuest.com.
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About RegQuest (http://www.RegQuest.com)
RegQuest, Your Regulatory Compliance Resource, details many of the regulatory, business and legal forces directly impacting health plans, care management organizations, employers and other stakeholders. Currently, the must-have online guide includes 50 state surveys and details how federal regulatory requirements impact the medical management system, including utilization management (UM) and external review (ER) processes. Coming soon, additional subscription modules will be available for purchase detailing grievance procedure (GP), mental health parity (MHP) regulations, and much more. RegQuest offers insightful and detailed reports on a variety of topics providing its subscribers with actionable information. For subscription information or to schedule a demo, contact us at info(at)regquest(dot)com or (443) 808-0818.