Doing More With Less: Positive Cost Containment

Positive cost containment can begin with not paying for down time. Administrative resources dedicated to case and claim processing sit on your books as solid, steady expense while the processing pipeline swings dramatically. Paying overtime when backlogs occur will definitely impact the monthly administrative budgets. A number of other factors also contribute to these swings.

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4 Targets For Resource Improvement

revenue cycle

Many hospitals are currently asking themselves, “How can we improve our revenue cycle in 2015?”
This topic is also one many C-suite executives are facing in 2015, which is proving to be another year of vast changes. Financial departments will have to stay on top of contract management, as well as planning for shifts in how payments are received.
Today, we’ve put together a list of 5 ways healthcare providers can reboot their revenue cycles and stay ahead of those changes that impact the bottom line.

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Posted in Revenue Cycle Improvement, Services

Adding Value With Behavioral Health

Bridging The Gap Between Medical And Mental Health Care

Providers are beginning to bridge the gap between medical and mental care, forming partnerships aimed at improving patients’ physical and mental health, and reducing costs at the same time. Such holistic projects are underway in numerous states, including California, New York, Washington, and Florida.

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Posted in Behavioral Health Integration, Clinical Analysis, Clinical Operations Improvement

Data Management Is Denial Management

Denial Management:

You know your reimbursement process needs attention when the response to an adverse determination is to resend the exact same paperwork through the pipeline. In a few cases, the ROI on a resend appears reasonable, but peel back the band-aid and you will find a process needing attention. Understanding data management is denial management begins the healing process.

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Posted in Quality Improvement Programs, Revenue Cycle Improvement

Delegation For Workers Compensation

workers compensation independent medical reviews

Across the country more and more workers compensation organizations are utilizing Workers Compensation Independent Medical Reviews to keep claims on track, and to decrease unnecessary expenditures as they relate to legal proceedings. When choosing an independent medical review network ask if they offer delegation for workers compensation medical reviews. Delegation provides an opportunity for significantly lower administration expenses wile increasing the quality of reviews.

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Posted in Health Care Reform, IRO, Physician Advisor/Peer Review

Patient Care And Cost Containment

Any serious discussion of patient care and cost containment must include a discussion about utilization review and management. Sometimes these two terms are used interchangeably, while their meanings and processes are quite different in reality.

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Posted in Accreditation, Services, URAC Accreditation, Utilization Management

4 Medical Necessity Criteria Challenges

Understanding and determining medical necessity criteria challenges can be very complex for physicians, clinicians, coders, and billers.

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Posted in Managed Care, Physician Advisor/Peer Review, Services

Levels Of Care Coordination

Medical Necessity and Levels of Care (LOC) criteria are interdependent sets of objective and evidence-based health guidelines used to standardize coverage determinations, promote evidence-based practices, and support a patient’s recovery and well-being. Being such, LOC application, documentation, and accuracy plays a pivotal role in care and reimbursement.

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Posted in Managed Care, Physician Advisor/Peer Review, Services

Utilization Review Reform Here?

Is California blazing a trail with their recent session’s addressing utilization review reform? Will the other states follow in their steps and how quickly?

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Posted in Accreditation, Compliance

Maximizing Physician Advisor Services

Physician Advisors are quickly becoming integral to care review, cost containment, and denial management. Choosing the right model for Physician Advisor Services can be difficult. You want to trust the model and team you choose because the PA services network interacts very closely with your clinical professionals.

Posted in Physician Advisor/Peer Review, Services


BHM Healthcare Solutions
5601 Mariner St
Suite 230
Tampa, FL 33609
Office: (888) 831-1171
Fax: (888) 818-2425

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