MEDICAL AUDIT
The service of medical audit that MCO offers implies critical and periodical evaluation of medical quality delivered to client´s beneficiaries, through revisions of healthcare procedures given by providers hired to such effect.
Failure to update patient’s daily evolution in his clinical record.
Inhuman manner displayed by professionals and personnel.
Over-invoicing of medicines and supplies.
Lack of attention and lack of management dealing with complaints.
Unnecessary requests of tests and practices.
Inadequate infraestructure of premises.
Medical and nursing miscalculations.
POTENTIAL MANAGEMENT BENEFITS
Lower cost in hospitalization due to early discharge.
Contribution of on-site and written and information in shared audits.
Audit’s denial to unnecessary hospitalization procedures.
Supervision when referring patients to mayor complexity centers.
Burocratic compliance, in due time and manner, in submitting benefits that can be reimbursed.
Supervise the execution of the Basic Medical Plan as a whole, specially the execution of prosthetic inputs, according to said plan.
Direct communication, information and emotional support to hospitalized beneficiaries and their families. Continuous reporting to central audit sectors of trade-union run medical insurance as required.
Possibility of auditors partial or full time disposal in selected companies.
ULTIMATE GOALS
To give more efficient healthcare assistance.
Alert clients and comment on every possible deflection of current regulations.
Maximize performance and control of costs.
Contribute to development of client´s progress.
Optimize quality of service and beneficiaries’ satisfaction.
AUDIT ON HEALTH INVOICING
We have a medical-administrative team specialized in billing control from service suppliers to financial backers, with the purpose of monitoring and making the pertinent deductions.
The service guarantees an excellent service and transparency standing as a control previous to invoicing payments. This is performed outwardly.
This pattern produces a direct economic impact on the company´s unjustified expenditures.
