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).
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.
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.
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.
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.
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.
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.
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.
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.