Medical Review Solutions

RISING’s Medical Review unit consists of highly trained healthcare professionals who provide a complete continuum of medical management and review services. These services facilitate early intervention, reduce unnecessary future treatment, and generate significant cost savings.

>> Prospective Review Solutions

RISING employs registered nurses, veteran case managers, and physician advisors who administer programs that guide patients and insurers through the medical care process. To generate cost effective outcomes, our medical professionals encourage appropriate treatment, rapid recovery, and an expedited return to the workplace.

Our Prospective services include:

• Utilization Review / Pre-Certifications
• Telephonic Case Management
• Catastrophic Care
• Triage Programs
• Discharge Planning

>> Concurrent Review Solutions

RISING’s Independent Medical Examinations (IMEs) and Utilization Reviews (URs) provide insight to the medical complexity and origin and treatment of an injury.  These solutions provide claims personnel with defensible medical evidence through detailed assessments of the diagnosis, relatedness to accident, appropriateness of care, and future treatment needs.

To ensure the integrity of RISING’s Concurrent programs, our IMEs and URs are performed by currently practicing, board certified physicians who are well versed in applicable laws and are willing to testify. RISING performs a comprehensive physician credentialing process which includes a thorough review of medical licensing, including sanctions, hospital privileges, education and professional liability insurance. All physicians on our panel are re-credentialed annually.

Our IME and UR services include:

• Concurrent peer review
• On-site job modifications
• Permanency ratings
• Apportionment ratings
• Detailed evaluation reports that are “court ready”
• Credentialed physicians

>> Retrospective Review Solutions

When services have already been rendered, RISING’s Medical Record Reviews can assist with a complete evaluation of treatment delivered, appropriateness of care, and/or review of charges. We utilize experienced, objective medical professionals and peer reviewers that carefully analyze a claimant’s medical care. Using established clinical criteria, RISING's Retrospective program provides insurers with the tools needed to facilitate fair and equitable case resolutions related to past medical treatment.

Our Medical Record Review services are beneficial when:

• Claim has incurred charges greater than $2500
• More than 15 visits to the same provider
• Questionable relatedness and/or reasonableness of treatment
• Aggravated or exacerbated pre-existing condition
• Injuries are catastrophic and/or permanent
• Frequent specialty consultations/diagnostic testing
• There is a delay in reporting injury / seeking treatment
• Lack of documentation or a detailed treatment plan