Cyber-attacks Vulnerable Healthcare Industries

WannaCry ransomware attack jumped cyber threat levels to new heights. Particularly hard hit were healthcare facilities in the UK. Three news articles summarize the attack and address healthcare industry's vulnerability. The US missed the brunt of the lockdown because of an accident in the form of an entrepreneurial coder inadvertently tripping the "kill switch". Cyber-attacks vulnerable healthcare industries missed the 10 years of preparation.

By | 2017-05-17T01:48:58+00:00 May 17th, 2017|Healthcare IT, Services|0 Comments

Out of Box Ideas: Prior Authorization Reform?

Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations today urged health plans, benefit managers and others to propose prior authorization reform requirements imposed on medical tests, procedures, devices, and drugs.

Outsourcing Complex Claims and Cases Review

Both payers and providers cannot find enough specialized talent for reviewing complex cases and claims, especially, behavioral health care. This unfortunately leads to in-house staff making decisions and hoping the decisions stick. Revenue processes need razor-thin efficiency in this new age of healthcare and using experienced personnel for making high risk decisions makes the most of your resources.

What Is Medical Review: Why Is Vital For Payers And Providers?

Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements. Here are 10 instances which can help you better identify when its time to look for a partner.

Health Insurers Of The Future:
What Are They And How Are They Built?

PwC’s Health Research Institute (HRI) released the results from a post-election survey focusing on models of health insurers of the future and the expectations of future members. The results and impacts outlined in their website report, identifies missions and investments for organizations best suited for targeted populations. Here are 10 instances which can help you better identify when its time to look for a partner.

Checklist for Outsourcing Reviews

Many payers and providers look to independent review organizations (IROs) as first-tier entities to gain efficiencies with decision-making and for an outside perspective on case documentation, utilization, and levels of care. So how do you know when it's time to start working with an IRO? Here are 10 instances which can help you better identify when its time to look for a partner.

Levels of Care Impact Medical Necessity Review Success

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).

By | 2017-04-05T11:22:26+00:00 April 5th, 2017|Accreditation, Services, Uncategorized|0 Comments

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