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