Medical Necessity and the Role of Physician Services

Medical necessity is a medical claims determination which encompasses outcomes which are justified as reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care. Evidence-based medicine (EBM) aims to apply the best available evidence to clinical decision making. It seeks to assess both the of risks and benefits of treatments and diagnostic tests and […]

BHM Healthcare Solutions Launches Enhanced PRS Portal

BHM Healthcare Solutions, a healthcare consulting firm first introduced the PRS portal for providing physician peer reviews in August 2011.  Since then, BHMs IT Department has made continual improvements to the PRS Portal to increase automation, efficiency, and responsiveness.

Part 2 – Peer Reviews: NAIRO’s External Review Regulations

NAIRO’s External Review Regulations The National Association of Independent Review Organizations (NAIRO) was formed in 20012 by a group of URAC-accredited Independent Review Organizations (IROs). The group’s purpose is to provide uniform regulations from state to state by simplifying the regulated independent review organization application process and independent medical peer review requirements among the states. […]