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.
ASAM Criteria set guidelines for length of stay and level of care for behavioral health. BHM Healthcare Solutions offers objective peer reviews based on medical necessity criteria, like ASAM's, for complex, medical, and behavioral health cases.
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.
An Independent Review Organization (IRO) deliver independent medical peer review services designed to ultimately reduce administrative costs and ensure patients receive proper treatments. Rising healthcare costs affect millions of people daily. Providers and insurers can rely on IROs to help them to control costs and offer affordable coverage.
BHM announced that it has been awarded re-accreditation as an Independent Review Organization from URAC
More Americans are turning to technology first to evaluate health conditions, and a growing number are interested in using the internet to access medical care, while opportunities remain to improve peoples’ understanding of basic health insurance terms and the connection between lifestyle choices and disease, according to a new study. UnitedHealthcare shares results in a new report.