One critical aspect often becomes a significant stumbling block - denial management. Denials can be a major source of financial strain for healthcare providers, leading to delayed reimbursements and increased administrative burden.
Physician peer reviews involve the assessment of a healthcare professional's clinical performance by their colleagues. This process aims to evaluate the quality of care provided, adherence to best practices, and compliance with professional standards.
The vast amount of medical information available, combined with the intricacies of various treatment options, can leave patients and their families feeling overwhelmed and uncertain about the best course of action. This is where physician advisors step in to provide invaluable assistance.
Independent Review Organizations (IROs) play a crucial role in providing unbiased and expert evaluations. This article explores the significance of Independent Review Organizations, their role in upholding trust and expertise, and how they contribute to enhancing the quality of healthcare services.
Health plan headaches begin with several challenges while navigating the rapidly evolving healthcare landscape. These challenges are driven by a combination of factors, including rising healthcare costs, regulatory changes, technological advancements, and shifting consumer expectations.
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 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.
A Peer-to-Peer Review is a conversation between two healthcare professionals, usually licensed doctors, over the phone discussing a patient’s case. The Peer-to-Peer (P2P) process is used to explain or clarify something the clinical record cannot convey clearly. The core of a P2P call basically focuses on matching medical necessity criteria with reimbursement criteria.
BHM Healthcare Solutions, Inc., (BHM), a leader in medical and behavioral health review services and healthcare analytics, announces the retirement of Jean Neiner, President and CEO, effective December 1, 2022. With this change, we are excited to announce that Eric Rosenberg will move into the position of President and CEO.