The Medical Rehabilitation Consultants Utilization Review Nurse Consultant medical background and knowledge enabled her to recognize that a typical request for spinal fusion and associated requested procedures might not be appropriate for this client. After a thorough record review, it was found surgery did not meet established medical necessity criteria for this diagnosis; therefore, the procedure was determined to be not medically necessary. This determination was confirmed with a secondary physician review by a Board Certified Specialty Physician.

Cost Savings:

• Avoided spinal fusion professional fees: $ 51,727

• Avoided spinal fusion facility fees: $ 132,799

• Specialty Physician Review: $ (462)

Total Cost Savings: $ 184,064