Significant advances in medical technology are allowing today’s surgeons to provide many surgical treatment options in an outpatient setting, enabling a speedier recovery and, ideally, at a lower overall cost than a traditional inpatient setting. However, due to several factors, including typically higher reimbursement rates for outpatient surgery and less effective overall PPO discount arrangements for outpatient procedures, many outpatient procedures are more expensive today than their inpatient counterparts.

Promote conservative treatment options

BMS CareConnex™ Outpatient Utilization Review program ensures that selected outpatient procedures are medically necessary and in the best medical and financial interest of the patient. Our clinical staff reviews alternate courses of treatment with the patient’s physician providers, ensuring that other clinically proven, but more conservative, treatments have been exhausted prior to approval of an expensive outpatient surgical procedure.

Flexible parameters - customized solutions

Unlike an inpatient review program, in which every admission should require evaluation, outpatient review should be tailored to suit each client. A white collar employer’s population will demonstrate dramatically different outpatient utilization patterns versus a manufacturing entity, and both will be different than a medical services provider such as a hospital. BMS CareConnex™ nurses, in conjunction with BMS account management and with input from the plan administrator and/or employer, will review the plan’s detailed outpatient experience and recommend plan-specific outpatient review criteria.