About Eric Duchinsky

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So far Eric Duchinsky has created 140 blog entries.

Medical Loss Ratio: Updates and Impact

Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the ACA, Medical Loss Ratio.

Medical Director Legal Risks

Medical directors face novel legal risks for professional liability, regulatory compliance, licensure board complaints, and careless communication habits. A more thoughtful understanding of the distinct obligations and potential medical director legal risks may help medical directors and their employers avoid unnecessary stress and minimize the chances of legal entanglements.

By | 2017-04-18T19:35:54+00:00 April 18th, 2017|Training|0 Comments

Hurdles Blocking Faster Reimbursement Processes

Imaging faster reimbursement cycles must include reviewing processes on both sides of the payer/provider relationship. Too many decades of combative mudslinging makes a comprehensive review and retooling difficult. New organizational structures, like ACOs, begin breaking down barriers allowing for collaborative improvements.

By | 2017-04-10T21:35:57+00:00 April 10th, 2017|Financial Analysis, Revenue Cycle Improvement|0 Comments

Survey Results Define CMO Responsibilities

Health reform puts healthcare organizations at more financial risk than ever for care costs and quality, both inside and outside their workplace. But it doesn't change the fundamental fact that physicians, even employed physicians, remain the final arbiters of what care actually is provided. CMO responsibilities evolve with need and business acumen grows as a vital need.

By | 2017-04-19T17:20:54+00:00 April 10th, 2017|Training|0 Comments

Levels of Care Impact Medical Necessity Review Success

Level of Care Guidelines are usually derived from generally accepted standards of behavioral health practice. These standards include guidelines and consensus statements produced by professional specialty societies, as well as guidance from governmental sources such as CMS’ National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

By | 2017-04-05T11:22:26+00:00 April 5th, 2017|Accreditation, Services, Uncategorized|0 Comments

Behavioral Healthcare Shortages: Causes and Solutions

The National Council for Behavioral Health and the National Council Medical Director Institute released a far-reaching report this month: The Psychiatric Shortage: Causes and Solutions. As a recognized leader in behavioral health reviews, this BHM Healthcare Insider Blog brings selections from the executive summary focusing on the behavioral healthcare shortages and solutions.

Successful Delegation To Downstream Entities

Healthcare organizations face challenges regarding reduction of their medical and administrative costs because regulatory and administrative demands are increasing. Payers and providers must evaluate new partner relationships and solutions for work processes and potentially outsource administrative functions in order to offer competitively priced services to patients. Successful delegation requires planning.

By | 2017-04-04T17:27:42+00:00 March 29th, 2017|Compliance, Operational Analysis, Uncategorized|0 Comments

Behavioral Health Costs: Success Stories

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.

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.

By | 2017-04-05T15:25:56+00:00 March 21st, 2017|Uncategorized, Utilization Management|0 Comments

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