If you're considering NCQA accreditation, it's important to understand the different levels that can be achieved. These status levels are based on compliance and performance reviews through NCQA and say quite a bit about your organization. Let's take a look at the different levels.
Specialty pharmacy is a growing industry and with many pharmacies moving toward accreditation, the process can get overwhelming. The following infographic will review some basics of the new CPPA Specialty Pharmacy Accreditation.
NCQA Accreditation is an on-going effort. Even after the initial processes are finished, there are new processes, technology, and standards that have to be worked into your daily work. But for those who are preparing for their first go-around with NCQA accreditation, there are a few measures you can take to ensure the process goes smoothly and without any major hiccups. Let's take a look.
Claims get denied for a variety of reasons - some of them are extremely simple to remedied, while others may require entire shifts in your organizational structure. The question is, could any of them been prevented? Many claim denials are completely avoidable - and in fact there are practical ways you can combat claim denials. Look at the following common claim denial reasons and see if any of them have happened to you recently.
Maybe you've heard us talk about IROs before, but you're still not 100% certain why you really need one. Independent Review Organizations have many features and benefits that extend beyond the realm of medical neccesity. In today's post, we'll make the case for IROs so the full picture becomes more clear.
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.
The AMA reports that up to 5% of claims are denied, and that number is only expected to rise (perhaps by as much as 200%) with the initial implementation of ICD-10 later this year. Medical billing and coding, which is undergoing enormous changes with the implementation of ICD-10, is always an area where additional training for staff can be a positive investment in denial management. Providing continuing education for coders can help them be better prepared to identify potentially problematic documentation, and be able to code with the highest level of accuracy. It’s often been said that the best defense against denials is — frankly — avoiding denials, but if that’s proving uneasy, if it seems to be near-impossible, the next best defense is to do a root cause analysis so that you understand why the denials continue.
Did you know that the Affordable Care Act is effecting the staffing industry? The ACA regulations put into effect state "that companies with more than 50 employees must provide insurance to their employees." The new regulation has had a great impact on staffing, hiring and the staffing industry's future. The following infographic from Akken Cloud will give you some insight on the relationship between the ACA and the staffing industry as a whole.
Unfortunately, claim denials are simply unavoidable. Even the best practices have at least a 5% denial rate. So how do you reduce denials to the lowest possible percentage to keep your revenue cycle strong? The first step is understanding where and why denials happen in the medical billing world.
Technology may be revolutionizing the healthcare industry but while mobile health applications and cloud-based management are convenient, many think they may be compromising the privacy of healthcare data. The debate, which is so multifaceted there isn't one way of looking at it, centers around how the healthcare industry can embrace mobile health while still securing patient data. In light of the Anthem breach earlier this year, the issue is becoming even more of a hot topic.