Blog 2017-04-02T13:27:54+00:00

Out of Box Ideas: Prior Authorization Reform?

By | May 17th, 2017|Categories: Health Care Reform, Physician Advisor/Peer Review, Services|Tags: , , , , |

Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations today urged health plans, benefit managers and others to propose prior authorization reform requirements imposed on medical tests, procedures, devices, and drugs.

CMO-CFO Collaboration Marks Success

By | May 8th, 2017|Categories: Financial, Quality Improvement Programs|Tags: , , , , , , |

It is important to acknowledge that CMOs and CFOs speak different languages, have different perspectives and focus on different goals. It is absolutely critical for clinical and financial leaders to recognize and understand the pain points of their colleagues on the other side of the C-suite. The need for CMO-CFO collaboration is just as evident in the financial realm of health care organizations.

Outsourcing Complex Claims and Cases Review

By | May 8th, 2017|Categories: Physician Advisor/Peer Review, Quality Improvement Programs, Services|Tags: , , , |

Both payers and providers cannot find enough specialized talent for reviewing complex cases and claims, especially, behavioral health care. This unfortunately leads to in-house staff making decisions and hoping the decisions stick. Revenue processes need razor-thin efficiency in this new age of healthcare and using experienced personnel for making high risk decisions makes the most of your resources.

AHCA and Three Scenarios: Repeal, Replace, Repair

By | May 3rd, 2017|Categories: Health Care Reform, Health Insurance, Health Insurance Exchange|Tags: , , , , , |

Any similarities of the title of this blog and Goldilocks and the Three Bears belies the serious decisions needed for the next round of healthcare reform. Last month, PwC’s Health Research Institute (HRI) released another fantastic research piece that maps out three possible landing spots: repeal, replace, repair. Here are 10 instances which can help you better identify when its time to look for a partner.

What Is Medical Review: Why Is Vital For Payers And Providers?

By | May 2nd, 2017|Categories: Physician Advisor/Peer Review, Quality Improvement Programs, Services|Tags: , , , , |

Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements. Here are 10 instances which can help you better identify when its time to look for a partner.

Health Insurers Of The Future:
What Are They And How Are They Built?

By | May 2nd, 2017|Categories: Physician Advisor/Peer Review, Quality Improvement Programs, Services|Tags: , , , |

PwC’s Health Research Institute (HRI) released the results from a post-election survey focusing on models of health insurers of the future and the expectations of future members. The results and impacts outlined in their website report, identifies missions and investments for organizations best suited for targeted populations. Here are 10 instances which can help you better identify when its time to look for a partner.

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