About Brandon Ruse

Resources by BHM Healthcare Solutions

Understanding Medical Necessity: Key Factors and Guidelines

2023-09-19T15:04:01-04:00By |Clinical Analysis, Clinical Operations Improvement, Compliance|

Medical necessity, a term holding immense importance in the world of healthcare. It serves as the cornerstone for decision-making in medical treatments and procedures. In this comprehensive exploration, we will delve into the concept of medical necessity, its significance in healthcare, key factors that determine it, and guidelines that govern its application.

Art of Utilization Review: Balancing Care and Resources

2023-09-12T14:39:13-04:00By |Compliance, Operational Analysis, Utilization Management|

Utilization review involves evaluating the appropriateness and necessity of medical services to ensure that patients receive care that aligns with their needs while also managing costs. This blog explores the art of utilization review, highlighting its significance in achieving optimal patient care outcomes while balancing resource utilization and quality.

Mastering Denial Management: Strategies for Efficient Reimbursement

2023-09-12T14:39:14-04:00By |Clinical Operations Improvement, Financial Analysis, Healthcare Independent Review, Trends|

Denial management involves navigating the complex web of insurance claims, reimbursement processes, and regulatory compliance to ensure that rightful reimbursements are received for services rendered. This blog aims to delve into the strategies that empower healthcare providers to crack the code of denial management, achieving optimal financial outcomes while upholding the quality of patient care.

Unlocking the Power of Healthcare Case Management

2023-08-31T15:11:16-04:00By |Care Coordination, Lean Management, Operational Analysis, Utilization Management|

Nowhere is balance more evident than in the domain of case management, where the thorough examination of patient cases serves as the bedrock of informed healthcare decisions. Unlocking the power of healthcare case management requires optimizing both the efficiency of the process and the effectiveness of patient outcomes.

Advancing Healthcare through Physician Peer-to-Peer Collaboration

2023-08-22T17:42:23-04:00By |Care Coordination, Clinical Analysis, Healthcare Independent Review|

The challenges faced by healthcare professionals have become increasingly complex, demanding innovative solutions that go beyond traditional approaches. One such solution gaining traction is physician peer-to-peer collaboration—a concept that holds the potential to revolutionize healthcare delivery and drive advancements across the industry.

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