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).
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.
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?
Healthcare's landscape changes constantly, including the practice standards agreed to by their industries. URAC and NCQA offer a range of credentials for organizations which appear in more and more state laws and payer/provider contracts. Staying current with the latest policies means a full-time effort.
If you are in the market for an Independent Review Organization (IRO) partner, looking for an IRO that is accredited is a great first step. Accreditation ensures that you receive the highest quality in service and support as well as an IRO who follow strict federal and state regulations. Accredited IROs must comply with important federal and state standards and timelines, ensuring you receive quality support that will help you create efficiencies for your peer review program.
Telehealth and telemedicine services are becoming a critical options for patients and providers across the country. While helping close gaps in care and help patients who may not have easy access to services, telehealth will be a important part of healthcare change. It's estimated that by 2018 there will be 7 million patients who use telemedicine services, more than double the amount in 2013¹.
A new law has been passed in California requiring programs that organizations who conduct utilization review for workers’ compensation become accredited. SB 1160 names URAC as the designated organization to provide this accreditation. Organizations must seek accreditation by July 1, 2018.
PCMHs are a great option for practices looking to shift a care delivery model that not only lowers costs but also improves quality of care and healthcare outcomes. From comprehensive care to a commitment to care quality and patient safety, the PCMH is transform...
Telehealth services are becoming an increasingly popular option for patients across the US with over 10 million American utilizing some form of telehealth care. Telehealth spending is expected to hit $240 million by 2018¹. As the number of organizations providing telehealth services grows so do concerns surroudning quality of care, costs and compliance. URAC, one of the fastest growing health care accreditation agencies in the world, has launched a new telehealth accreditation.
Signed into law in 2015, the Medicare Access and CHIP Reauthorization Act (MACRA), centers on reimbursing providers for the value and quality of care they provide. The MACRA Quality Payment Program (QPP) is a proposed shift to the law itself and many healthcare organizations weighing-in.