Healthcare organizations face challenges regarding reduction of their medical and administrative costs because regulatory and administrative demands are increasing. Payers and providers must evaluate new partner relationships and solutions for work processes and potentially outsource administrative functions in order to offer competitively priced services to patients. Successful delegation requires planning.
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?
Last year, we published a blog about Washington State's IRO Transparency Project. As the ACA evolves into the next phase of healthcare, states continue using tools and resources developed over the past five years. BHM's continues in its role as a leader in IRO services with an update on Washington's project.
Many organizations struggle with developing policies and procedures. Formatting policies and procedures for accreditation and re-accreditation present special challenges. Policies and procedures form the foundation for a smooth accreditation process and are only the beginning of a longer accreditation journey. BHM’s accreditation consultants are experts in developing award winning policies and procedures. With extensive experience working with many organizations earning URAC, TJC, NCQA and other accreditations, BHM’s library of formatted and up-to-date policies and procedures is extensive.
Choosing an Independent Review Organization (IRO) for a meaningful partnership that drives improvement and cost savings can be a tough task. The importance of an IRO to help support effective decision making and give objective, unbiased reviews, can be crucial to your business. To ensure you choose an IRO that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology, you’ll want to do your research. It’s very important to trust the organization you choose and you always want to make sure they are industry certified. The following is a 5 part checklist for selecting the right IRO Partner.
We’ve been talking a lot lately about Independent Review Organizations and the appeals process that accompanies them. The role of the IRO in the appeals process is to provide an unbiased 3rd party opinion on complicated reviews, helping to assure that all reviews are given the time and care they deserve. It’s a common illusions in the healthcare industry that taking care of things in house is the best and easiest way to save money—however this isn’t true when it comes to claim reviews. If you are trying to manage your denials in-house, it can actually be counterproductive if you’re trying to save money and even time. Let’s take a look at how outsourcing your IROs can save you time and money.
One Month – Four Exciting Healthcare Web Events: Take Your Organization to the Next Level GalleryAccreditation, Care Coordination, Compliance, Financial, Financial Analysis, NCQA Accreditation, PCHCH Accreditation, Physician Advisor/Peer Review, Specialty Pharmacy Accreditation, Uncategorized, URAC Accreditation
1 Day Left to Sign up For BHM’s Free WebClinic “Components of a Great Peer Review Program” GalleryCompliance, News and Events, Physician Advisor/Peer Review, Quality Improvement Programs, Services, Strategic Planning, Training, Utilization Management, Webinar
BHM's webclinic “Components of a Great Peer Review Program” goes live Wednesday, November 18th from 12:00pm to 1:00pm EST. You don't want to miss this great opportunity to receive expert advice related to Peer Review Services. Don't worry you still have time to sign up!
If you think you might need an Independent Review Organization to provide unbiased peer reviews in a manner that complies with all federal and state regulations, BHM can help. Last week we talked about the top 5 reasons you might need an external IRO but this week we’re focusing on the real-life situations that might lead to you to hire an IRO. If your answer to any of these questions is “yes," you may want to look into hiring an IRO.
While you are looking for an Independent Review Organization (IRO) it’s always important to select an IRO that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. The best way to ensure that the IRO you choose has the highest standards of practice and full compliance to federal rules and regulations is to choose a URAC accredited IRO. It’s important to trust the organization you choose and make sure they are industry certified, choosing an accredited IRO ensures that the IRO of your choosing is fully equipped to service your organization.