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Levels of Care Impact Medical Necessity Review Success

Level of Care Guidelines are usually derived from generally accepted standards of behavioral health practice. These standards include guidelines and consensus statements produced by professional specialty societies, as well as guidance from governmental sources such as CMS’ National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

Independent Review Organization Can Save You Money 3 Ways

The role of the Independent Review Organization (IRO) in the appeals process is to provide an unbiased 3rd party opinion on complicated reviews, helping to assure that all reviews are given the time and care they deserve. It’s a common illusions in the healthcare industry that taking care of things in house is the best and easiest way to save money—however this isn’t true when it comes to claim reviews. If you are trying to manage your denials in-house, it can actually be counterproductive if you’re trying to save money and even time. Let’s take a look at how outsourcing your IROs can save you time and money.

4 Healthcare Trends Set into Motion by the ACA

Let's talk healthcare trends set into motion by the ACA. The Affordable Act was signed into law March 23, 2010 making 2015 the law’s 5 year anniversary. Can you believe it? Five years later the ACA has sparked change in the healthcare ecosystem and is continuing to churn the wheel of change. But what changes should healthcare organizations expect for the future? PwC Health published a report on post-ACA trends in honor of the law’s 5th anniversary. The report outlines 5 major healthcare trends, Risk Shift, Primary Care, New Entrants, Health Insurance, and States, that it believes the ACA set into motion. We will cover 4 of those trends today!

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