Blog Archives

Most Bang: Impactful Metrics For RCM

Analyzing Your Revenue Cycle

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.

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Posted in Financial, Financial Analysis, Services

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

4 Targets For Resource Improvement

revenue cycle

Many hospitals are currently asking themselves, “How can we improve our revenue cycle in 2015?”
This topic is also one many C-suite executives are facing in 2015, which is proving to be another year of vast changes. Financial departments will have to stay on top of contract management, as well as planning for shifts in how payments are received.
Today, we’ve put together a list of 5 ways healthcare providers can reboot their revenue cycles and stay ahead of those changes that impact the bottom line.

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Posted in Revenue Cycle Improvement, Services

Patient Care And Cost Containment

Any serious discussion of patient care and cost containment must include a discussion about utilization review and management. Sometimes these two terms are used interchangeably, while their meanings and processes are quite different in reality.

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Posted in Accreditation, Services, URAC Accreditation, Utilization Management

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

7 Ways to Lower Accreditation Risk

5 Ways to lower first-time accreditation risk

Healthcare’s landscape changes constantly, including the practice standards agreed to by their industries. URAC and NCQA offer a range of credentials for organizations which appear in more and more state laws and payer/provider contracts. Staying current with the latest policies means a full-time effort.

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Posted in Accreditation, Services

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

Payers Find Fix For Volatile Market Changes

Payers look to contractors for help as healthcare reform continues to drive change in the industry. From cutting costs to processing claims, there is an urgent need among payers for outsourcing. Claims management services are expected to see the biggest spike in growth in the coming years¹.

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Posted in Services

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