| BHM understands the importance of payer-provider relationships. Providers implementing one key quality check can cut expenses and streamline processes while building payer relationships. Clinical Case Shaping leverages our physician advisory network to identify gaps in meeting medical necessity criteria and addresses the entire case. Click here to learn more options. |
Administrative inefficiencies keep payers and providers from building collaborative relationships focusing on patient care. Provider strategies can lead the way for shaving percentage points off administrative expenses. Taking a page out of the manufacturing sector playbook, providers map administrative work like factory line and reap the benefits. Integrating quality checks at a key paperwork bottleneck can quickly turn a negative to a positive.
“Providers and payers will have shifting accountability—and more potential for risk. As a result, they will need to better align themselves to save overall costs and ensure more accurate and timely reimbursements.” reported Becker’s Hospital CFO www.beckershospitalreview.com in May 2016.
“For instance, if information is inaccurate or completely missing on a claim, the provider must then submit additional or corrected information to the payer. This means the provider often waits an additional cycle to receive payment.”
Provider Strategies
Integrating a dynamic physician advisory program for case review establishes a quality check before finalizing and processing claims for reimbursements. Efficient physician advisory programs use clinical case shaping to identify gaps in meeting the medical necessity criteria.
Providers can begin by leveraging predictive analytics to improve their financial clearance. More specifically, they must use analytics to proactively manage claims that are likely to be denied and make corrections to inaccurate or incomplete claims before they’re submitted to payers.
Data mining the case data collected through the advisory program takes the next step for long-term improvements. Target areas where improvement plans can deliver the greatest ROI by slicing and dicing data based on important variables.:
- Turn Around Time,
- Concordance rates,
- Case managers,
- Physician advisory reviewers, and
- Levels of Care (LOC)
Integrating a culture prioritizing First-Pass Accuracy with case management minimizes administrative expenses due to redundancies. Seeing the financial benefits of the growing value-based payment structures demands a prioritization of administrative efficiencies.
Get a jump on the many benefits of engaging physician advisory services with BHM.
BHM understands the importance of payer-provider relationships. Providers implementing one key quality check can cut expenses and streamline processes while building payer relationships. Clinical Case Shaping leverages our physician advisory network to identify gaps in meeting medical necessity criteria and addresses the entire case. Click here to learn more options.
