Necessary Evil? 5 Medical Necessity Criteria Issues To Overcome

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.

By | 2017-04-02T13:27:55+00:00 February 28th, 2017|Physician Advisor/Peer Review, Services, Uncategorized|0 Comments

Stretching Medical Directors Too Far?

As healthcare continues to change, so do some of the roles within the industry, but no role has perhaps experienced a shift quite as significant as the Medical Director.  This position has taken on a dramatic evolutionary shift in responsibility and scope. The roles and responsibilities now require stretching medical director skills into contract negotiations, group dynamics, organizational development, team management, and many areas not covered in a traditional medical curricula.

By | 2017-04-26T18:19:21+00:00 February 20th, 2017|Training, Uncategorized|0 Comments

Doing More With Less: Positive Cost Containment

Positive cost containment can begin with not paying for down time. Administrative resources dedicated to case and claim processing sit on your books as solid, steady expense while the processing pipeline swings dramatically. Paying overtime when backlogs occur will definitely impact the monthly administrative budgets. A number of other factors also contribute to these swings.

By | 2017-04-02T13:27:55+00:00 February 15th, 2017|Uncategorized|0 Comments

4 Targets For Resource Improvement

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.

By | 2017-04-02T13:27:55+00:00 February 14th, 2017|Revenue Cycle Improvement, Services, Uncategorized|0 Comments

Adding Value With Behavioral Health

Providers are beginning to bridge the gap between medical and mental care, forming partnerships aimed at improving patients’ physical and mental health, and reducing costs at the same time. Such holistic projects are underway in numerous states, including California, New York, Washington, and Florida.

Data Management Is Denial Management

You know your reimbursement process needs attention when the response to an adverse determination is to resend the exact same paperwork through the pipeline. In a few cases, the ROI on a resend appears reasonable, but peel back the band-aid and you will find a process needing attention. Understanding data management is denial management begins the healing process.

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