UTILIZATION MANAGEMENT PROGRAM
MEDICAL CASE MANAGEMENT PROGRAM
CHRONIC DISEASE MANAGEMENT PROGRAM
HEALTH WELLNESS & SUPPORT PROGRAM
EXPECTRUM: SRS' PRENATAL WELLNESS PROGRAM
SRS MANAGEMENT
Spectrum Review's strength is in the management team of professionals. A brief summary of the team's backgrounds follow:
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Frank J. Berrier, Jr., Ph.D. Chairman, President and CEO. Dr. Berrier has over 25 years of direct management experience in cost containment and quality management programs for HMO's and PPO's. As a Vice President of a managed care organization, Dr. Berrier was instrumental in the development and implementation of a national private review company and provided senior management expertise to the company's PPO and TPA operations. As an Executive Director of a government funded Professional Standards Review Organization (PSRO), he designed and implemented medical cost containment programs within the public sector. Dr. Berrier has remained an active and leading member of national and local utilization review/quality assurance organizations and is board certified through the National Association of Healthcare Quality Professionals. He is a frequent guest lecturer on managed care at local and state medical organizations. Dr. Berrier holds two doctorates in Health Care Management and in Psychology. He is also trained and experienced as a Mediator and Arbitrator and has a private practice for these two services, specializing in Health Care Mediation and Arbitration.
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John R. Gerdes, M.D.
Spectrum Board Member and Medical Director is a graduate of the University of Texas Southwestern Medical School, Dallas, Texas and is a Diplomat & Fellow of the American Board of Obstetrics and Gynecology. Dr. Gerdes is also a past president of the General Medical Staff and member of the Board of Directors of Columbia Rosewood Medical Center, Houston, Texas. He has been in private practice in Houston, Texas for the last 38 years.
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Clifford M. Kitten, M.D. Associate Medical Director. A practicing physician for over 18 years, Dr. Kitten is board certified by the American Board of Surgery and the American Board of Thoracic Surgery. He is an active member of the American College of Surgeons, American College of Cardiology, M. E. De Bakey International Cardiovascular Surgical Society, D.A. Cooley Cardiovascular Surgical Society, Texas Medical Foundation, and the Harris County Medical Society.
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Ernest C. Munshower, BA Chief Operating Officer - Corporate Secretary/Treasurer. Mr. Munshower has over 19 years of general business experience, including 15 years in healthcare and managed care settings. Mr. Munshower has over 8 years experience in accounting and management information systems. His combined managed care, accounting and computer experience is an essential ingredient in the success of SRS.
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Brenda S. Dusenbury Vice President, Administration, Ms. Dusenbury is a native Houstonian, with over 20 years of general business experience, including 13 years in healthcare. In addition, she has over 15 years experience in accounting and management information. She has been with Spectrum Review Services for over 9 years and has become a real asset to the Companies success.
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Nancy S. Anecelle, R.N. Member, Spectrum Review Services Board of Directors and Managed Care Consultant to Spectrum. Ms. Anecelle has over 17 years experience in healthcare and managed care. Her extensive experience includes the development of Preferred Provider Organizations (PPO) provider networks, plan design and employee educational programs. She has been very successful in marketing of managed care products directly to employers, third party administrators, insurance carriers and to other managed care organizations. In addition to several years experience as an RN in the hospital environment, Ms. Anecelle has managed and administered the provider relation activities for several PPO organizations, most recently for a group of hospitals doing direct contracting through a joint PPO effort. She has been considered a leader within the healthcare community with respect to managed care.
SRS PHYSICIAN PEER REVIEW PANEL
SRS has recruited nationally and has signed agreements with some seventy-five private physicians, an independent contractors, to provide physician to physician, specialty matched, peer review for all cases which do not meet standard ISSI criteria previously screened by non-physician reviewers. Only a physician peer reviewer can make a negative determination in regard to medical necessity questions.
SRS' panel represents the major specialties and sub-specialties, however, we have chosen to exclusively utilize the services of Prest & Associates, Inc. for psychiatric and substance abuse physician peer review. This national organization provides the services of numerous sub-specialties for this complex area of review. It should also be noted that many state laws now require that only physicians licensed within the state in which the case is questioned have a right to perform a review.
CHIROPRACTIC & PT/OT PEER REVIEW PANEL
SRS has seen the need for the review and audit of Chiropractic, PT/OT claims and has created the Spectrum Review Services Chiropractic, PT/OT Peer Review Panels. The panels are designed to assist SRS in reviewing claims for appropriateness of treatment(s) and to determine usual and customary fees for billed charges. These programs are focused at claims payers who have a large chiropractic or PT/OT benefit and who need a way to contain costs in this area.
Claims are reviewed for one low fee per claim. We ask that all appropriate documentation accompany a request for review and audit, including; initial exam report and physician evaluations, all related report findings such an X-ray, MRI and CAT. The complete itemized bill should be provided for evaluation. Spectrum will have the case reviewed by a panel member and have an answer back, usually within one week from receipt, provided additional information is not needed.
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