Medical Loss Ratio: Updates and Impact

Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. Revisiting one of the ACA, Medical Loss Ratio.

Hurdles Blocking Faster Reimbursement Processes

Imaging faster reimbursement cycles must include reviewing processes on both sides of the payer/provider relationship. Too many decades of combative mudslinging makes a comprehensive review and retooling difficult. New organizational structures, like ACOs, begin breaking down barriers allowing for collaborative improvements.

By | 2017-04-10T21:35:57+00:00 April 10th, 2017|Financial Analysis, Revenue Cycle Improvement|0 Comments

Most Bang: Impactful Metrics For RCM

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.

Understanding Value Based Reimbursement

The healthcare industry has undergone major changes since the rollout of the Affordable Care Act and now a new type of reimbursement model is putting traditional incentive based payment models on the shelf for good. Value based reimbursement, which ensures that providers are rewarded for performance, quality, and cost reduction (instead of number of services provided), is a model that will help shape the future of healthcare.

4 Key Points to Consider When Choosing a Healthcare Accreditation

Last week we introduced Gwen Roberts, SVP of BHM’s Consulting Division and discussed common questions that come up when organizations start the accreditation journey, focusing mainly on choosing between URAC and NCQA health plan accreditation. This week we are focusing on four key elements organizations should consider when deciding between healthcare accreditation bodies. Since many organizations have very diversified programs and levels, it’s important to understand the culture and expectation of your own organization first. Here are four helpful points that you can use as a guide as you begin your journey towards accreditation.

By | 2017-04-02T13:28:08+00:00 December 21st, 2015|Accreditation, Financial Analysis, NCQA Accreditation, Organizational Analysis, Services, URAC Accreditation, Webinar|Comments Off on 4 Key Points to Consider When Choosing a Healthcare Accreditation

3 Ways Independent Review Organizations Help Save You Money

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.

By | 2017-04-02T13:28:09+00:00 December 3rd, 2015|Accountable Care Organizations, Clinical Operations Improvement, Compliance, Financial, Financial Analysis, IRO, Services, Webinar|Comments Off on 3 Ways Independent Review Organizations Help Save You Money

One Month – Four Exciting Healthcare Web Events: Take Your Organization to the Next Level

Healthcare Web Events

End of the Year Healthcare Web Events You Won’t Want to Miss!

The end […]

By | 2017-04-02T13:28:09+00:00 December 1st, 2015|Accreditation, Care Coordination, Compliance, Financial, Financial Analysis, NCQA Accreditation, PCHCH Accreditation, Physician Advisor/Peer Review, Specialty Pharmacy Accreditation, Uncategorized, URAC Accreditation|Comments Off on One Month – Four Exciting Healthcare Web Events: Take Your Organization to the Next Level

5 Ways Revenue Cycle Management (RCM) Reduces Errors & Increases Revenue

With new advances in the way medical information is transcribed, stored and transferred, technology has created more variables to a provider’s success than ever before. Between tangling with mountains worth of paperwork, handling claims denials and riding the learning curve of new systems like EHRs and ICD-10 coding, there can be lots of room for error and, consequently, potential revenue that slips through the cracks. Luckily, revenue cycle management systems are here to help. They can streamline a vast array of your most intensive processes — like admitting, coding, balancing budgets, billing and filing claims — in order to provide a supreme level of oversight and control. This control in turn helps you avoid common RCM problems that lead to lost revenue, profitability and productivity.

By | 2017-04-02T13:28:09+00:00 November 6th, 2015|Clinical Operations Improvement, Financial, Financial Analysis, Revenue Cycle Improvement, Services|Comments Off on 5 Ways Revenue Cycle Management (RCM) Reduces Errors & Increases Revenue

Cutting Costs Through the Medical Loss Ratio & Independent Review Organizations

Healthcare spending is on the rise. The federal government has begun several initiatives to control costs, increase efficiency, and increase quality. A couple of these initiatives as outlined in the ACA are the Medical Loss Ratio and the increased prominence of Independent Review Organizations.

By | 2017-04-02T13:28:12+00:00 September 8th, 2015|Financial, Financial Analysis, IRO, Physician Advisor/Peer Review|Comments Off on Cutting Costs Through the Medical Loss Ratio & Independent Review Organizations

8 Helpful Questions To Jump-Start Your Accreditation Journey

Thinking about accreditation? Here are 8 helpful questions that you can use as a guide to help ease your organization into the accreditation process. We will group the eight questions into four simple steps, in order to help you jump-start your accreditation journey with ease.

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