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Review Services

2018 marked MPRO’s 34th year of offering review services to a growing base of customers across the U.S. Our service offerings have continually evolved to meet an ever-changing range of needs to help promote better, more efficient care and care delivery. Currently, review services offered by MPRO include Informal Dispute Resolution (IDR) and Independent Informal Dispute Resolution (IIDR) for skilled nursing facilities, external medical review, utilization review and Virtual CMO, an all-new peer review service.


Informal Dispute Resolution (IDR)/Independent Informal Dispute Resolution (IIDR)

In 2018, MPRO solidified its position as a national leader in IDR/IIDR with a customer base that includes 20 percent of the states in the U.S. Current customers include the Illinois Department of Public Health, Indiana Department  of Health, Commonwealth of Kentucky, Michigan Department of Licensing and Regulatory Affairs, Mississippi Department of Public Health, North Dakota Department of Health, Ohio Department of Health, Tennessee Department of Health, Texas Health and Human Services Commission, West Virginia Health and Human Resources. Highlights of our work in 2018 include:

  • Contract renewals – Renewed contracts with five of our customers including Illinois, Kentucky, Mississippi, North Dakota and West Virginia.

  • Reviews – With an annual total of 570 cases that included 1,780 tags reviewed, 2018 marked an all-time high in the number of reviews conducted by MPRO.

  • Onboarding reviews for the state of Texas – in Q1 2018, we completed on-boarding operations to conduct reviews for the state of Texas (including Texas-based MPRO staff).

  • Fully launching the MPRO IDR portal and related instructional videos and training materials.


External Medical Review

In 2018, MPRO continued to provide external review and medical necessity review services for a customer base that includes the Detroit Wayne Mental Health Authority, Michigan Department of Health and Human Services, Office of the Montana State Auditor Commissioner of Securities and Insurance, North Carolina Department of Insurance and Total Health. Over the course of 2018, MPRO provided over 125 case reviews.


Utilization Review

Since 1988, MPRO has provided prospective and retrospective utilization review services for the Medicaid Fee-for-Service (FFS) population for the Michigan Department of Health and Human Services. The work encompasses a broad spectrum of reviews that include the Prior Authorization Certification Evaluation Review (PACER) program; the Durable Medical Equipment (DME), Medical Supplies (MS), and Ventilator Dependent Care Unit (VDCU) Authorization program; and the Nursing Facility Level of Care (LOC) Exception/Immediate Review Process. In FY 2018, MPRO conducted a total of:

  • 6,223 reviews to support the PACER program (authorizations of inpatient admissions, inter-hospital transfers, readmissions within 15 days, and continued-stay reviews).

  • 5,170 reviews for the DME/MS/VDCU program.

  • 1,227 reviews for the LOC Exception/Immediate Review program.


Virtual CMO/Peer Review

In 2018, MPRO launched and all new service line: Virtual CMO. Virtual CMO is specifically designed for small and critical access hospitals that cannot afford the luxury of a fully-staffed medical leadership team. Services offered include a highly targeted, flexible array of professional services that are typically associated with a fully-staffed medical leadership team without the expense and difficulty that comes with hiring, training and retaining this level of expertise. In addition to peer review services, Virtual CMO also offers denial management services, staff education and credentialing, and direct personal involvement. In 2018, MPRO secured three all new Virtual CMO customers including:

  • Big Horn Hospital Association – Hardin, MT

  • Scheurer Hospital – Pigeon, MI

  • Hayes Green Beach Memorial Hospital – Charlotte, MI

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