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Because of CIMRO’s extensive experience in healthcare quality improvement spanning 36 years, we are aware that utilization management is not only about containing costs, but also about ensuring that quality care is provided at every level of service. CIMRO has conducted nearly 2 million retrospective, admission, and continued stay reviews. We were instrumental in reducing the average length of stay (ALOS) for general care from 4.4 days to 2.8 and the ALOS for psychiatric care from 13.1 to 8.9 for a state government client serving nearly two million Medicaid beneficiaries. The number of bed days per 1000 also decreased from 900 to 620 as a direct result of CIMRO’s utilization management services. 

CIMRO can tailor services to meet individual client needs. Our highly qualified staff, experienced in all aspects of utilization review, can perform telephonic preadmission and/or concurrent review, as well as retrospective medical record review, onsite or offsite. CIMRO’s physician membership includes more than 1,500 practicing physicians, with nearly 700 physicians actively involved in CIMRO review programs. CIMRO has at least one physician reviewer available in every recognized specialty. Our reviewers utilize current national standards of practice in determining medical necessity and whether a requested treatment is considered investigational or experimental. Interrater reliability rates are stable and average 99.4% and 98% for nurse and physician reviewers, respectively.

Customized reports can be provided on a monthly or quarterly basis which detail utilization statistics including the overall number of approvals/denials, denials by DRG, and estimated cost savings. Annually, recommendations can be made to modify review focus to improve quality of care and maximize cost savings.