For over 40 years, OFMQ has been a leading utilization review organization, holding URAC Accreditation since 2006.  OFMQ is an established leader in Medicare, Medicaid, and various other healthcare industry reviews.  OFMQ can provide high quality, comprehensive and objective utilization management and independent review services for hospitals and health plans.  OFMQ is accredited in Health Utilization Management and Independent Review.

OFMQ performs traditional Utilization Management (UM) reviews as well as customized focused reviews on client specified cases.  We provide professional medical oversight designed to promote optimal clinical overcomes through appropriate utilization of medical and clinical resources, pre-certification, concurrent and retrospective review. We also provide recommendations for your Discharge Planning to meet your Conditions of Participation agreement with Medicare and Medicaid.

Is your documentation at risk?  Are you losing money by billing the wrong codes?  OFMQ’s coders are experts at conveying the basics of documentation and coding. We have presented coding inservices to small and large groups.

OFMQ’s Utilization Management reviews consist of:

  • Nurses, Coding Specialists, and Board Certified Physicians covering a full range of clinical services and settings – including specialty programs.
  • A focus on the medical appropriateness and setting, level of care and quality of care, DRG and coding validation (or customized to the provider’s needs).
  • Strict adherence to URAC standards.