Diagnoses:

Spinal Stenosis in Cervical Region; Backache; Pain in Limb

Summary:

The provider’s office contacted the MRC Utilization Review Department to request a two-stage neck surgery. The participant would remain in the hospital and have the second stage four days after the first stage of surgery. The MRC UR Nurse Consultant researched multiple criteria sites and did not find where all the procedures and the extended stay were medical necessary. Due to the extensiveness of the requested surgery and the request for the additional inpatient stay, a secondary review by a Board Certified Specialty Physician confirmed the MRC UR Nurse Consultant findings. Again, a requested peer-to-peer conference was conducted and the determination of non-medical necessity was upheld.

Cost Savings:


• Avoided second neck surgery professional fees: $ 51,134

• Avoided second neck surgery facility fees: $ 147,595

• Specialty Physician Review: ($ 924)

Total Cost Savings: $ 197,805