Utilization review involves evaluating the appropriateness and necessity of medical services to ensure that patients receive care that aligns with their needs while also managing costs. This blog explores the art of utilization review, highlighting its significance in achieving optimal patient care outcomes while balancing resource utilization and quality.
Nowhere is balance more evident than in the domain of case management, where the thorough examination of patient cases serves as the bedrock of informed healthcare decisions. Unlocking the power of healthcare case management requires optimizing both the efficiency of the process and the effectiveness of patient outcomes.
Medical case reviews play a crucial role in enhancing quality improvement and patient safety within the healthcare system.
Healthcare auditing plays a crucial role in ensuring the delivery of quality care and adherence to standards within healthcare organizations. By systematically assessing performance, healthcare audits provide valuable insights into areas of success and areas that require improvement. Let's explore the importance of healthcare auditing in more detail.
Effective healthcare strategies play a vital role in driving better health outcomes for patients and populations. This blog post discusses examples of effective healthcare strategies and provides tips for developing and implementing them.
Intelligent Document Processing (IDP) is a technology that uses artificial intelligence (AI) and machine learning to automatically extract and process data from documents such as claims forms, invoices, and medical records. This eliminates the need for manual data entry and speeds up the processing of claims and other documents.
Health System Best Practices: Profitable health systems tend to exhibit certain behaviors and policies that distinguish them from less profitable ones. Here are some of the most common.
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.
Data Collection is key. Healthcare now relies on increasingly large amounts of data for maximizing both artificial intelligence (AI) and revenue cycle management (RCM) systems. BHM Healthcare Solutions understands the value of data in getting healthcare organizations to next-gen analytics.