Blog Archives

Behavioral Health Costs: Success Stories

Behavioral Health Integration

Managing behavioral health costs challenges the US healthcare system. The issues encompass many of the legacy processes and structures needing to be overhauled. Some interesting recently posted examples may show the way for the entire healthcare system. These come from both payers and providers.

Tagged with: , , , , , ,
Posted in Behavioral Health Integration, Clinical Analysis, Clinical Operations Improvement

Independent Medical Review (IMR) Hits High In CA

An analysis of the California workers’ comp independent medical review (IMR) process used to resolve medical disputes finds that in 2016, IMR physicians once again upheld about 90% of utilization review (UR) physician’s modifications or denials of treatment, yet IMR volume continued to grow, climbing 6.5% last year.

Tagged with: , , , ,
Posted in Uncategorized, Utilization Management

AHCA Impact On Payers

The American Health Care Act (AHCA) made its debut. Not many people in government and healthcare industries expect quick passage of the AHCA in its initial form, but understanding the differences with the Affordable Care Act (ACA) sets a framework for how payers prepare for the final version. Fair to say, every organization must make adjustments and the pressures for building internal organization-level efficiencies increase.

Tagged with: , , , , , ,
Posted in Trends, Uncategorized

AHCA Impact On Providers

The American Health Care Act (AHCA) made its debut. Not many people in government and healthcare industries expect quick passage of the AHCA in its initial form, but understanding the differences with the Affordable Care Act (ACA) sets a framework for how providers prepare for the final version. Fair to say, every organization must make adjustments and the pressures for building internal organization-level efficiencies increase.

Tagged with: , , , , , ,
Posted in Trends, Uncategorized

4 Payer Success Cases vs Opioids

Payer Success Cases focus on tangible and continuous improvements. In January 2017, the healthcare industry saw the release of a white paper…

Tagged with: , , ,
Posted in Uncategorized

Payers’ Big Step For Easing Provider Tension

Easing provider tension begins building trust with payers. A little trust and understanding go a long way towards more efficient payer-provider relationships. One concrete effort, by payers, not only benefits both parties, but builds trust for the long-term.

Tagged with: , , ,
Posted in Uncategorized

Most Bang: Impactful Metrics For RCM

Analyzing Your Revenue Cycle

Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart.

Tagged with: , , ,
Posted in Financial, Financial Analysis, Services

Necessary Evil? 5 Medical Necessity Criteria Issues To Overcome

Why Claims Are Denied

In the 1970s, as part of the extended managed care infrastructure, new external institutions for supervision of medical necessity, appropriateness, and quality of care were formed. Even after these many decades of use, medical necessity criteria present five issues that still cause grief and need attention for MNC success.

Tagged with: , ,
Posted in Physician Advisor/Peer Review, Services

Medical Director Turnover: Crisis? What Crisis?

Last week, our blog, “Stretching Medical Directors Too Far?” covered the new roles and responsibilities for chief medical officers and medical directors. FULL BLOG. Today’s blog focuses on the financial impact and possible solutions for medical director turnover.

Tagged with: , , ,
Posted in Uncategorized

Stretching Medical Directors Too Far?

As healthcare continues to change, so do some of the roles within the industry, but no role has perhaps experienced a shift quite as significant as the Medical Director.  This position has taken on a dramatic evolutionary shift in responsibility and scope. The roles and responsibilities now require stretching medical director skills into contract negotiations, group dynamics, organizational development, team management, and many areas not covered in a traditional medical curricula.

Tagged with: , , , ,
Posted in Training

Pin It on Pinterest