We conduct independent medical case review for providers and health plans under private contracts to meet our clients credentialing, risk management, utilization management and DRG/coding validation needs.
MetaStar performs a thorough review of medical records to assure that medical care delivered met professionally recognized standards of care. We have provided these services directly to providers on a limited basis out of state for many years. Recent changes in federal rules for Medicare Quality Improvement Organization (QIOs) allow us to offer these services more broadly to providers and health plans in the state of Wisconsin.
- Experience and Expertise
As the Medicare QIO and the Medicaid External Quality Review Organization (EQRO) for Wisconsin since 1973, MetaStar has extensive experience providing medical case review services. We also have served the needs of providers, mostly out of state, under private contracts for over a decade. Our physician reviewers are in active practice, board-certified and undergo MetaStar’s strict credentialing process. Nurse reviewers have clinical experience and years of experience in case review. They are thoroughly trained in review procedures and proficient in evidence-based guidelines.
We take rigorous steps to assure the independence of our organization and physician reviewers. As a QIO, our organization must demonstrate that we meet the requirements of the Social Security Act which requires, among other things, that we must not be a health care facility, health care facility affiliate or health care association. We use physician reviewers that are not economic competitors to your organization or on the same medical staff to eliminate potential conflicts of interest and assure an objective, non-binding, peer review.
- Physician Network
We maintain a robust network of physician reviewers in 35 specialties and match the specialty and practice setting (urban/rural) of the case to the appropriate physician reviewer for a fair peer review. If the precise match desired is not in our network, we will draw on our relationships with thousands of physicians to meet your needs including finding an out of state physician reviewer. All physician reviewers are in active practice, board-certified and undergo MetaStar’s strict credentialing process.
Confidentiality is a high priority at MetaStar. The physician reviewer’s finding is non-binding and reported only to you. The physician reviewer’s name is kept confidential. We have strict and comprehensive physical, electronic and procedural security systems in place to ensure the confidentiality of our clients’ records. These systems are subject to periodic scheduled and unscheduled audits by the Centers for Medicare & Medicaid Services (CMS) and NCQA. Electronic files of medical records and other documents can be sent confidentially through our Secure File Transfer system. This system, which was evaluated by a third party and is monitored continually for security, has been used successfully for several years. It uses SSL 128 encryption and requires a user ID authenticated with a password for access.
- Easy Access
Clients with established Service Agreements simply complete the provided requisition and send it with the medical record(s) to MetaStar’s secure facility.
- Sampling Support for Credentialing or Practice Evaluation
Multiple records are usually reviewed for credentialing or practice evaluation purposes. Our biostatistician will assist you in developing a statistically sound sampling strategy.
- Reliable Procedures
As an organization that achieved Mastery level recognition for the Wisconsin Forward Award Criteria for Performance Excellence ,we are committed to the Baldrige framework for performance management and use effective and systematic approaches to our work. We have documented standard operating procedures (SOPs) and forms to support key processes.
We use an electronic system to track your medical records from the time they arrive at our secure facility and note each transition as they progress through the review process, are stored and finally shredded. The nurse reviewer evaluates all documentation for completeness and prepares a synopsis with a list of concerns to facilitate an efficient and effective physician review. The entire medical record with the nurse’s synopsis and questions are sent to the physician reviewer(s). The final report is drafted by the nurse the from the physician reviewer’s response and reviewed by our Medical Director.
Most cases are complete within 30 to 45 days. We welcome inquiries as to the status of the review. Our review nurses can easily check the medical record tracking system to quickly determine the status of the case. (Note: Fast Track/Expedited Appeals of discontinued Medicare-covered service for Medicare beneficiaries are completed within 72 hours/7 days a week.)
- Cost Efficient
Professional fees are charged on an hourly basis for actual time spent. There are no charges for administrative time and no per case administrative fees - especially important for reviews of multiple cases for credentialing or practice evaluation purposes.
(800) 362-2320 or (608) 274-1940