Blog Archives

Necessary Evil? 5 Medical Necessity Criteria Issues To Overcome

Why Claims Are Denied

In the 1970s, as part of the extended managed care infrastructure, new external institutions for supervision of medical necessity, appropriateness, and quality of care were formed. Even after these many decades of use, medical necessity criteria present five issues that still cause grief and need attention for MNC success.

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Posted in Physician Advisor/Peer Review, Services

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

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

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

IRO Transparency Project: Summary

IRO Industry Innovation

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.

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Posted in Compliance, Physician Advisor/Peer Review, Population Health, Quality Improvement Programs, Uncategorized

5 Tips for Medical Directors

Medical Directors Peer Review Process

Whatever the title, Medical Director, CMO, or similar, the responsibilities loom large with little relief in sight. Burnout, recruitment, and retention might be a larger concern than medical necessity criteria, case shaping, and utilization management. The end of the ACA won’t likely make things easier. With that in mind, here are 5 time-saving tips for medical directors.

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Posted in News and Events, Physician Advisor/Peer Review

Accredited IROs Promote a Transparent and Quality Review Process

IRO

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.

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Posted in Physician Advisor/Peer Review, URAC Accreditation

5 Tips for Choosing Physician Advisor Services

Choosing the right Physician Advisor Services can be difficult. It’s important to look for a Physician Advisor Services that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified.

Posted in Physician Advisor/Peer Review, Services

Free Webinar: Beyond Concordance Rates

Free Webinar:

Beyond Concordance Rates:
BHM’s New Innovations for Improving the Peer Review Process

BHM Healthcare Solutions debuts its exciting new web-based suite of data reporting tools! BHM is at the forefront of data mining allowing clients to do a deeper dive on case data. Unlike any other reporting tool in the market today, BHM’s peer review system facilitates more data capture, data mining – analysis, reporting and review. Managing your case data more effectively will reduce costs, improve productivity, and maximize your resources.

Posted in Physician Advisor/Peer Review, Trends, Webinar

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