Healthcare Independent Review

Enhancing Collaboration in Medical Necessity Criteria

2024-02-07T08:08:12-04:00By |Care Coordination, Clinical Operations Improvement, Healthcare Independent Review, Operational Analysis, Revenue Cycle Improvement, Uncategorized|

Collaboration between healthcare providers and payers is instrumental in navigating the complexities of medical necessity criteria. By fostering a cooperative environment, both parties can work together to ensure that medical decisions align with the best interests of the patient.

Mastering Denial Management: Strategies for Efficient Reimbursement

2024-02-07T08:00:02-04:00By |Clinical Operations Improvement, Financial Analysis, Healthcare Independent Review, Trends|

Denial management involves navigating the complex web of insurance claims, reimbursement processes, and regulatory compliance to ensure that rightful reimbursements are received for services rendered. This blog aims to delve into the strategies that empower healthcare providers to crack the code of denial management, achieving optimal financial outcomes while upholding the quality of patient care.

Advancing Healthcare through Physician Peer-to-Peer Collaboration

2023-08-22T17:42:23-04:00By |Care Coordination, Clinical Analysis, Healthcare Independent Review|

The challenges faced by healthcare professionals have become increasingly complex, demanding innovative solutions that go beyond traditional approaches. One such solution gaining traction is physician peer-to-peer collaboration—a concept that holds the potential to revolutionize healthcare delivery and drive advancements across the industry.

Understand Claim Denials Affecting Reimbursement in Healthcare

2024-02-07T07:52:10-04:00By |Healthcare Independent Review, IRO, Operational Analysis, Physician Advisor/Peer Review, Revenue Cycle Improvement, Utilization Management|

To understand claim denials affecting reimbursement requires data. In healthcare, claim denials occur when an insurer or payer refuses to reimburse a healthcare provider for a particular medical service or treatment. Claim denials can occur for a variety of reasons, such as inaccurate or incomplete billing information, lack of medical necessity, or failure to follow the proper billing procedures.

Independent Peer Review Streamlines RCM

2023-03-15T13:37:41-04:00By |Healthcare Independent Review, IRO, Operational Analysis, Physician Advisor/Peer Review, Revenue Cycle Improvement, Utilization Management|

Independent peer review plays a crucial role in revenue cycle management for the healthcare industry. Revenue cycle management (RCM) refers to the process of tracking patient care from registration to final payment, including all the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

Healthcare Independent Review and ‘No Surprise Act’

2022-10-19T14:51:08-04:00By |Healthcare Independent Review, IRO, Payer Trends|

Understanding the Vital Role, Challenges, and Opportunities of Independent Medical Review Services, offers a behind-the-scenes look at internal and external appeals, reasons why accredited IROs reduce risks, and a crash course on newer review services, such as the independent dispute resolution process that’s part of the No Surprise Act (NSA) surprise billing regulations.

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