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!
5 Key Elements of the Peer Review Process
Lately we have been talking about the important of Independent Review Organizations (IROs) and peer reviews in the healthcare ecosystem. Today we continue this discussion and delve deep into the importance of the peer review process. We know that peer reviews are a crucial part of healthcare because they hold medical professionals and organizations accountable in addition helping to build a world of trust between patient and physician. The peer review process is one that consists of high levels of property technology and superior customer service. By boosting transparency in healthcare, peer reviews have become an essential standard helping to make healthcare safer and more efficient. So let’s take a look at the 5 core building blocks of the peer review process.
The Road To NCQA Health Plan Accreditation
Are you a health plan looking into NCQA accreditation? We know that the process can be daunting and often stressful, so we’ve compiled a list of NCQA basics to help those who are pondering an NCQA accreditation. If you are a health plan who has already chosen to pursue NCQA accreditation, take a look at our blog post "NCQA Health Plan Accreditation : The Difference Between Failure and Success." For those of you just getting started let's dive into the NCQA basics, from who the NCQA is to an overview of their Health Plan accreditation levels. Hopefully this list helps jump-start your journey towards successful healthcare accreditation.
Eliminating Risk with Independent Review Organizations
We’ve been talking a lot lately about how and where Independent Review Organizations, or IROs, fit into denial management. The Peer Review process, which brings in an unbiased third party to help alleviate the pressure of reviewing claims, is an essential part of denial management. We’ve touched on many of the different benefits of IROs in previous blog posts, from how they affect your ROI to how they bring specialized expertise to reviews. This blog post focuses on the four main ways IROs and external reviews can help eliminate risk within your organization.
NCQA Presents HEDIS 2016 Volume 2 with Relevant ICD-10 Codes
The NCQA announced on September 29, 2015 that the 2nd volume of HEDIS 2016 (The Healthcare Effectiveness Data and Information Set) would be completely ICD-10 compliant and ready for the implementation day of OCT 1. The NCQA has phased out the ICD-9 codes as per NCQA regulations and added over 73,000 ICD-10 codes, across 56 HEDIS measures. "Health plans, health data clearinghouses and health care providers will now be able to code records to comply with CMS requirements for HEDIS reporting."
NCQA Releases Health Insurance Plan Ratings For 2015-16 & Debuts New Rating System
On September 17, 2015 the NCQA announced the release of the 2015-16 Health Insurance Plan Ratings, debuting the new ratings methodology as well. These ratings, which are shift from the "ranking" system previously used by the accrediting body, compare the services and quality of over 1,000 health plans. These ratings "provide consumers with a more accurate picture of how health insurance plans perform in key quality areas." The easy to use system lets consumers search for health plans by state, and plan name or plan type (Private, Medicaid, Medicare). Consumers can also sort the listings by Accredited Status, Consumer Satisfaction, Prevention, and Treatment (in addition to rating). Top performers nationwide, with an overall 5.0 rating and 4.5 Consumer Satisfaction include: Capital District Physicians' Health Plan, Harvard Pilgrim Health Care, Kaiser Foundation Health Plan of Northern California.
Don’t forget! Sign Up For Our FREE Accreditation Success Webinar 9/17!
Join us 9/17 at 1PM CDT and learn the top strategies that make the difference between accreditation success and failure. Through research, expert interviews, and hands on work with some of the top national organizations we have discovered the keys to accreditation success....and they might not be what you think! This is a must attend event for anyone undergoing accreditation or re-accreditation. Discover essential components on how to maximize your accreditation success rate, save your organization money, and get the most out of your accredited status.
Join Us 9/17 For Our FREE Webinar: The Secrets to Accreditation Success!
Through research, expert interviews, and hands on work with some of the top national organizations we have discovered the keys to accreditation success....and they might not be what you think! This is a must attend event for anyone undergoing accreditation or re-accreditation. Discover essential components on how to maximize your accreditation success rate, save your organization money, and get the most out of your accredited status.
6 Benefits of Becoming Accredited & Some Exciting News!
Accreditation comes in all shapes in sizes, but at its core, it can be defined […]