Medical review is the collection of information and clinical review of medical records by physician advisors (for providers reviewing cases before submissions) or a peer review team (for payers) to ensure that payment is made only for services that meet coverage, coding, and medical necessity requirements. Here are 10 instances which can help you better identify when its time to look for a partner.
The Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs. When it comes to the cost of prescription drugs, our healthcare system faces four major challenges: high list prices for drugs; seniors and government programs overpaying for drugs due to lack of the latest negotiation tools; out-of-pocket costs for consumers; and foreign governments free-riding off of American investment in innovation.
The prices hospitals negotiate with health insurance companies vary enormously within and across geographic regions in the United States, according to a new study coauthored by Zack Cooper (Yale), Stuart Craig (University of Pennsylvania), Martin Gaynor (Carnegie Mellon), and John Van Reenen (London School of Economics).
Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart.
WEA Trust, a Wisconsin-based not-for-profit insurer, does that by protecting patients prescribed opioids for the first time. Its pharmacy utilization management program limits initial opioid prescriptions to a seven-day supply. WEA Trust also collaborates with providers to ensure opioid prescriptions are evidence-based and medically appropriate. In just five months, opiate prescriptions dropped 27 percent, with 91,000 fewer pills dispensed.
A new survey exams the attitudes, perspectives, and plans of healthcare leadership that are shaping telemedicine’s application, value, and potential. The research explored telehealth services adoption rates and drivers, budgets and ROI, the technology’s role in delivering care, and the factors important to executives when selecting a solution for their organization.
Analyzing your revenue cycle from start to finish can lead to recouping significant revenue dollars for your organization. Knowing what are the most impactful metrics sets revenue cycle experts apart.
Healthcare is a labor-driven service that depends on the talent and skills of every staff member, from the C-suite to nurses. Finding and keeping this talent is paramount to running a cost-effective organization that provides exceptional care was an observation from an article by Mackenzie Bean by Becker Hospital Review. Growing turnover rates significantly impact profitability.
NCQA’s Health Insurance Plan Ratings 2017–2018 compare the quality and services of more than 1,000 health plans in the United States and provide consumers with a practical and meaningful guide to understanding their health care options and choosing the best health plans for themselves and their families. National Committee for Quality Assurance (NCQA) is releasing its 2017 Health Insurance Plan Ratings. These ratings provide consumers with a more accurate picture of how health insurance plans perform in the key quality areas of consumer satisfaction, prevention and treatment.
Now in its third year, Numerof’s State of Population Health Management survey provides an in-depth, national look at the pace of change from fee-for-service. Conducted in collaboration with Dr. David Nash, Dean of the Jefferson College of Population Health, the study synthesizes survey responses from more than 400 executives and interviews with key decision makers across U.S. healthcare delivery