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.
Understanding and determining medical necessity criteria challenges can be very complex for physicians, clinicians, coders, and billers.
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.
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.
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.
Outsourcing is not a new word for healthcare. The speed of growth of outsourced services is new. Now administrative services joins the ranks of services under outsourcing consideration. A recent survey indicates providers look to outsourcing Physician Advisor complex case review and complex claims review, because they anticipate a decline in reimbursements and inpatient margins narrowing further next year. Almost a 20% growth from 2013 to 2016.
Peer Reviews are necessary to remove Conflict of Interest inherent in a healthcare environment by reducing the potential for the organization to make financially driven decisions when applying the Medical Necessity Criteria (MNC) to patient care.
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.
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.
Choosing the right Peer Review Program can be difficult. It’s important to look for a Peer Review Program 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. Use these 5 tips to help you choose a Peer Review Program or use as a guide for your current vendor.