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.
The Centers for Medicare & Medicaid Services (CMS) finalized a new rule that gives providers and employers better access to Medicare and private sector claims data. CMS hopes that the improved access will help organizations make more informed decisions about care delivery and quality improvement.
The concept of continuous improvement is widely known throughout the healthcare world. When it comes to peer review programs, it can make or break a claims process. A peer review partner can help ensure that your organization stays up-to-date on technology cycles, legislation changes, and any other important shifts in the healthcare industry.
The healthcare industry is taking critical steps towards moving behavioral healthcare off the back burner and into the spotlight. As demand for behavioral and mental health services across the continuum of care continues to grow, there is wide spread opportunity for healthcare organizations to become champions for primary care and behavioral health integration.
Join BHM experts Tuesday, December 15 at 12:00 PM CST for the complimentary webinar “Components of a Great Peer Review Program.” This not-to-miss exclusive event will reveal essential components that organizations need to create a Peer Review program that provides added and ongoing value to healthcare organizations.
There are times when we all can benefit from an outside perspective, in both life and in work. For healthcare, this outside perspective comes in the form of external Independent Review Organizations (IRO). An external IRO not only give perspective that differs from “insider” knowledge, but it’s also views situations in an entirely new light with set a quality set of standards and procedures. In some cases an external IRO may be required, but if not they are still a highly beneficial option. External IROs offer a unique perspective that is not only beneficial, but entirely necessary. Here are 3 reasons why outsourcing your IRO is a good idea.
Are you looking for an Independent Review Organization? Do you know what questions to ask and on what basis to compare? Not all Independent Review Organizations are equal. Independent Review Organizations (IROs) can be either internal or external. Independent are within the organization whereas external are completed by neutral third parties who are external to the organization.
Many case managers look to Independent Review Organizations (IROs) to get help with decision-making and for outside perspective from a trusted source. For some, their collaboration is required. 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.
IROs and peer reviews an essential part of healthcare the healthcare ecosystem. Why? They help hold healthcare organizations and providers accountable in addition to providing key educational resources for learning as well as evaluation. A URAC accredited IRO “assures that organizations that facilitate independent medical peer review are free from conflicts of interest, establish qualifications for clinical reviewers, address medical necessity and experimental treatment issues, have reasonable time periods for standard and expedited reviews, and appeals processes.” The peer review process also adds transparency, which in turn helps build trust between patients and providers. Here are 5 reasons you need an Independent Review Organization (IRO).