Helping Providers Assure Quality Care for all BHP Members

Medicus Resource Management works closely with providers to assure appropriate, high-quality care for all members. Currently, Medicus employs two full-time case managers, a Medical Director, and five full-time nurses who conduct research on available treatments and facilities across the country, in addition to those located in Berks County.

Medicus staff have the ability to negotiate discounts with providers, and serve as mediators between insurance carriers and employers. Staff members recommend reasonable reimbursement levels to help reduce costs for patients. As part of a multi-disciplinary treatment team tailored to meet the individual needs of members, Medicus staff members can provide physicians with several viable options to present to members. It is recommended that providers work closely with Medicus when making decisions with patients concerning potentially expensive and complex inpatient or outpatient care.

Medicus provides the services listed below for BHP providers:

Administration of Concurrent Review:
this process evaluates the appropriateness of a continued hospital stay or medical resource consumption during each admission. In order to expedite this process, Medicus works closely with the hospital’s Utilization Review Department to determine the medical necessity of a prolonged stay. The concurrent review process consists of:

• Contacting the attending physician whenever the nurse reviewer requires additional information pertaining to the appropriateness of a continued stay.
• Reviewing all patients who remain hospitalized past the initially approved length of stay to assure the necessity of the level of care. If continuation of care is certified, the review process continues until discharge or until the stay is no longer medically necessary.

Transition between Levels of Care:
Assessment of discharge needs is continuous throughout a member's hospitalization. Inpatient stays are continuously monitored for quality of care and assistance with discharge planning. Medicus works with providers to identify treatment options and locate facilities for patients who require further care, but not hospital confinement. Staff will answer questions concerning availability of treatment and the appropriateness of various facilities. Please note: Authorization from Medicus is required before a BHP member is discharged from one facility and placed in another.

On-site Concurrent Reviews:
A Medicus nurse is on site at The Reading Hospital and Medical Center to obtain clinical information pertinent to your patient's hospital stay and to answer any questions you may have regarding authorizations and facility options for your patients. Our nurses work closely with the hospital's utilization review department to coordinate discharge planning requirements. These services are designed to assist providers to best meet the needs of their patients.

Coordination of Services for Your Patients:
If you are preparing to meet with a patient to discuss, for example, a bone marrow transplant, various outpatient cancer treatments, a prescription plan for expensive medications, or a discharge plan to a skilled nursing or other type of facility, please feel free to call Medicus Resource Management at 610-372-8417 for assistance in coordinating these services.

Our staff will research hospitals, doctors, outpatient facilities, discounts and costs for your patient, then give you – the physician – the opportunity to present several alternatives to your patients and their families. A simple phone call to Medicus could insure your patient's continued care is not only good, quality care, but also authorized by his or her insurance carrier to help avoid unnecessary out of pocket expenses for your patient. Let Medicus save time for you and your staff. – call us today!