A Peer-to-Peer Review is a conversation between two healthcare professionals, usually licensed doctors, over the phone discussing a patient’s case. The Peer-to-Peer (P2P) process is used to explain or clarify something the clinical record cannot convey clearly. The core of a P2P call basically focuses on matching medical necessity criteria with reimbursement criteria.
BHM Healthcare Solutions, Inc., (BHM), a leader in medical and behavioral health review services and healthcare analytics, announces the retirement of Jean Neiner, President and CEO, effective December 1, 2022. With this change, we are excited to announce that Eric Rosenberg will move into the position of President and CEO.
Hospital Safety Grades released, by the Leapfrog Group, a national nonprofit watchdog organization that advances patient safety in hospitals, the fall 2022 results.
Avoiding HIPAA violations goes beyond air tight technical system controls. Often the leaks and violations come through the human elements of healthcare operations.
More than 25 years after the first federal mental health parity protections were put in place, adequate coverage for behavioral health (BH) care, including both mental health and substance use conditions, remains elusive for many consumers with health insurance.
The federal government hit CVS Health and Centene with lower quality scores for the health-insurance plans they sell to seniors. Star Rating scores are a big deal for health insurers, because plans that score 4 stars or higher receive bonus payments from the federal government that they can use to edge out competition by funding new health-plan benefits to attract more customers.
Utilization Review and Utilization Management are very critical in the healthcare continuum. While the two terms often feel interchangeable, in reality their processes and meanings actually are very different. Their differences make all the difference for improving care.
URAC accreditation consulting valuation begins with seeing the importance of earning a credential. The multifaceted world of accreditation can be daunting, from choosing the right accreditation body to getting correct documentation in place to ensure accreditation success.
The roles and responsibilities now require stretching medical directors’ skills into contract negotiations, group dynamics, organizational development, team management, and many areas not covered in a traditional medical curriculea.
Understanding the Vital Role, Challenges, and Opportunities of Independent Medical Review Services, offers a behind-the-scenes look at internal and external appeals, reasons why accredited IROs reduce risks, and a crash course on newer review services, such as the independent dispute resolution process that’s part of the No Surprise Act (NSA) surprise billing regulations.