Resources by BHM Healthcare Solutions

Medication Adherence Higher in Patient Centered Medical Homes

November 16, 2016

The Patient Centered Medical Home is very important model of care that has been growing in popularity across the national. The PCMH is not specific place but more a model of care focused on accessible, coordinated, comprehensive, and patient centered care. PCMH are also committed to and is committed to quality and safety. The PCMH model is a great way for primary care organizations to put a stronger emphasis on care coordination and communication, which in turn helps transform primary care to be more patient-centered.

Key Components to a Great Peer Review Training Program

November 15, 2016

Peer Reviews are necessary to remove Conflict of Interest inherent in a healthcare environment by reducing the potential for the organization to make financially driven decisions when applying the Medical Necessity Criteria (MNC) to patient care.

HEDIS Helps Payers Close Gaps in Care

November 7, 2016

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used for health care performance measurement. Called the “Gold Standard” by the NCQA, HEDIS

CMS Pilot Program to Compare Network Breadth of Health Plans

October 27, 2016

In April of 2016, CMS announced that a new type of tool to help consumers compare the breadth of plans’ networks on HealthCare.gov. A recent update to that announcement (September 2016) has notified the public that the roll out should start in 2017, for a small number of states.

6 Tips for Reducing Claims Denials

October 25, 2016

Optimizing your revenue cycle starts with reducing denials. In order to do this, you must have an effective Denial Management strategy in place. According to a new HIMSS Analytics study, 56% of hospitals surveyed said they don’t use a vendor solution for claim denials. However, around 60% of those respondents are planning on purchasing a claims denials management tool within the next year. If you are part of the 40%, now may be the time to think about investing in tools for claims denials.

Turn Your Denials Around: Denial Management Focus

October 22, 2016

Health insurance claim denials could be causing your organization to lose a significant amount of revenue each year. An effective Denial Management strategy is one of the fastest ways to recoup lost revenue, and ensure that you are being paid for the care that you are providing.

Studies indicate that approximately 25-30% of healthcare claims are rejected or denied. This results in millions of dollars of lost revenue each year. The majority of these losses can be avoided by implementing our unique denial management process.

CMS Hospital Quality Score Cards Released

October 18, 2016

The Centers for Medicare & Medicaid Services released the final version of its hospital quality ratings Wednesday and posted them to the Hospital Compare website. Many of the most well-known hospitals in the nation received below average scores while lesser known facilities took the top scores.

New Study Reviews Payer Performance

October 14, 2016

Athena Health recently published the 2016 edition of Payer View, a in-depth review of the biggest payers in their network. Athena Health identifies the shift to value based care and healthcare reform as the biggest challenges to everyone for payers to providers.

Value-Based Payment Models and the Future of Healthcare

October 11, 2016

The Centers for Medicare & Medicaid Services (CMS) has been pushing value based models that focus on quality of care rather than quantity. This means that most traditional incentive based payment models are being put phased out. The CMS hopes to tie 90% of all Medicare payments to alternative payment methods by 2018. Unlike fee-for-service models, value based models tie quality and cost together. By doing this they can encourage providers to give the best possible care at the best possible cost.

Telemedicine Battles Opioid Epidemic

October 5, 2016

The nation’s addiction to prescription painkillers is hovering at epidemic levels. The CDC reported that in 2014 more than 14,838 people died from overdoses of drugs such as oxycodone. (cite). Providers are now forced to think of new and innovative ways to help stop the epidemic, which is tied closely to the opioid epidemic. Telemedicine has become a huge savior for many rural areas trying to fight drug related deaths and conditions.

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