Resources from BHM Healthcare Solutions

Free Webinar: Beyond Concordance Rates

2023-08-12T07:24:20-04:00By Eric Duchinsky|Physician Advisor/Peer Review, Trends, Uncategorized, Webinars|

Free Webinar: Beyond Concordance Rates: BHM’s New Innovations for Improving the Peer Review Process BHM Healthcare Solutions debuts its exciting new web-based suite of data reporting tools! BHM is at the forefront of data mining allowing clients to do a deeper dive on case data. Unlike any other reporting tool in the market today, BHM’s peer review system facilitates more data capture, data mining - analysis, reporting and review. Managing your case data more effectively will reduce costs, improve productivity, and maximize your resources.

Best Practices for Lowering Fraud

2023-09-08T15:42:48-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

Building strong payer/provider relationships is critical to lowering the risk of fraud. Because the nation’s health care industry uses third-party payers such as commercial insurers and Federal and State government, the relationship between payer and provider is one that needs a lot of care and attention. From coding to physical documentation, these 4 tips are outlined by the Department of Health and Human Services as the most important ingredients to successful payer-provider relationships.

13 Tips for HEDIS Success

2017-05-11T12:11:22-04:00By Eric Duchinsky|Big Data|

HEDIS is a tool used by 90% of America’s Health Plans to gauge performance on crucial aspects of care and service. By standardizing the way health plans collect, analyze, and report performance information and data, HEDIS creates an equal playing field for all health plans (who use HEDIS) to be compared. The tool is also used by health plans to learn which area they can improve in. On the other end, employers, consultants, and patients use HEDIS data to help them select the best health plan for their needs.

CMS Release Gold Mine of Data for Benchmarking Your Operations

2023-09-08T15:45:10-04:00By Eric Duchinsky|Big Data, Physician Advisor/Peer Review|

The Centers for Medicare & Medicaid Services (CMS) released Part 2 in a set of data that details information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The CMS believes that The Part D Prescriber PUF data will provide healthcare professionals with important information to drive change within the industry. “These data enable a wide range of analyses on the type of prescription drugs paid for under the Medicare Part D program, and on prescription drug utilization and spending generally.”

2017 EHR Incentive Program Details

2023-08-12T08:28:54-04:00By Eric Duchinsky|EHR|

The 2009 American Recovery and Reinvestment Act set up established payment adjustments under Medicare for eligible hospitals, who are not users of Certified Electronic Health Record Technology (CEHRT). According the CMS, hospitals that don’t demonstrate meaningful use for an EHR reporting “period associated with a payment adjustment year will receive reduced Medicare payments for that year.

ACOs Proving Success With $466 Million in Savings

2017-07-05T15:14:31-04:00By Eric Duchinsky|Accountable Care Organizations|

The shift to accountable care and value-based payment models is taking healthcare by storm. Accountable Care Organizations (ACOs), which focus on shared accountability and quality improvement, are becoming a popular model for many healthcare organizations looking to move forward in the new era of healthcare. Around 7.7 million Medicare beneficiaries receive care from an ACO. This has resulted in better care for the beneficiaries and a reduction in total costs.

Revisit: 5 Qs On Data Security

2023-10-09T12:11:46-04:00By Eric Duchinsky|Uncategorized|

Three data security stories caught my eye, this month. August 3: Banner Health suffers year's largest data breach; 3.7M affected August 15: Bon Secours vendor breach affects 655k patients August 22: OCR to investigate more breaches affecting 500 or fewer individuals As much as the details differ between the three stories, one worry comes true: cyber security threats are growing.

Isolate Errors Impacting Payments

2023-08-12T08:16:11-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

The medical reviews process is critical to healthcare ecosystem. The process helps protect against Medicare fraud and the many risks associated with atypical billing patterns and payments. The Social Security Act outlines very specific guidelines for reducing medical review error. Medicare contractors are used to help review data and medical records. Contractors ensure requirements for Part A and Part are in place and that claims data is reviewed for any errors. Through the collection of data and data analysis, medical reviews ensure that Medicare payments are not only met but also that they follow strict coverage, coding and medical necessity requirements.

Case Study For Provider Success

2023-08-12T08:10:50-04:00By Eric Duchinsky|Uncategorized|

Many healthcare organizations face financial and organization challenges due a wide array of changes in the industry. From changing legislation to shifts in the economy, organizations are forced to shift along with the industry. This rapid shift to a new healthcare emphasis on value based performance and consumer outcomes, has created even more opportunities for organizations to transform and grow. Change can be daunting. Improvement and transition can be difficult without the right tools. This is why many organizations look for help outside their own organization. Here is how one organization rode the waves of change and come out on top.

Tough Decision: 68% Payment Now or Take a Chance on Appeal

2023-09-08T15:41:36-04:00By Eric Duchinsky|Medicare and Medicaid|

Last year, the Centers for Medicare & Medicaid Services (CMS) paid $1.5 billion in billing settlements to one third of the nation’s hospitals. Now, CMS has released who got paid what. According to Kaiser Health News (KHN), “the settlements were a compromise to reduce a swollen backlog of disputes over what hospitals argued they were owed¹.”

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