Medical technology has advanced rapidly in recent years. Today many tests, surgeries, or procedures can be performed without requiring an overnight stay in the hospital. However, these procedures are still costly and should not be performed unless medically indicated. MedCost’s Outpatient Review Program assures that such procedures are indeed necessary and in the patient’s best interest. We assess and balance patient care quality, safety and cost-effectiveness.

The goal of our Outpatient Review Program is to reduce the number of unnecessary outpatient procedures while keeping the patient’s health and well being the top priority. The result for clients:

• Significant cost savings
• Cost-effective alternatives to expensive surgical procedures

MedCost’s Outpatient Review Program is versatile in that two types are available: a comprehensive, all-inclusive diagnostic outpatient review or a more focused outpatient review which monitors closely the procedures that are typically
overutilized.

The comprehensive program requires participants to call MedCost toll-free whenever a treating physician recommends any *outpatient procedure that will be performed outside of a physician's office. This program provides a gatekeeper for all scheduled surgical procedures and for some of the more commonly requested diagnostic procedures. MedCost’s nurses will consult with the treating physician regarding clinical information. The procedure will then be certified if the medical information meets MedCost’s professional criteria.

The program requires participants to call MedCost for certification for specific diagnostic procedures that have been identified as frequently overutilized.

*All diagnostic procedures performed in a physician's office require certification.