Physician Advisor/Peer Review Archives - BHM Healthcare Solutions

Physician Advisor Reviews Improve Patient Outcomes

Physician advisor (PA) reviews play a crucial role in improving patient outcomes by facilitating various processes within healthcare organizations. PAs act as liaisons between hospital administration, clinical staff, and support personnel to ensure compliance with regulatory issues, advise physicians on medical necessity, and help achieve overall organizational goals related to the efficient utilization of healthcare services. Physician advisors contribute to better patient outcomes through several key activities.

2023-06-01T17:42:32-04:00By Eric Duchinsky|Physician Advisor/Peer Review, Readmissions, Revenue Cycle Improvement, Uncategorized|

Prior Authorization AI and the Future

Prior Authorization AI and the Future - The process of prior authorization can be time-consuming and complicated for healthcare providers.

2023-05-05T12:10:10-04:00By Eric Duchinsky|Care Coordination, Payer Trends, Physician Advisor/Peer Review, Uncategorized, Utilization Management|

Understand Claim Denials Affecting Reimbursement in Healthcare

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.

2023-03-24T10:15:57-04:00By Eric Duchinsky|Healthcare Independent Review, IRO, Operational Analysis, Physician Advisor/Peer Review, Revenue Cycle Improvement, Utilization Management|

Independent Peer Review Streamlines RCM

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.

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

Peer-to-Peer Review Pitfalls & Solutions

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.

2022-12-14T15:49:19-04:00By Eric Duchinsky|IRO, Physician Advisor/Peer Review, Services|

Slow Progress Toward Total Value Based Care

Multispecialty medical group and integrated delivery system revenue is increasingly risk-based, but these organizations continue to experience barriers that slow their progress toward total value-based healthcare, according to a new survey.

2019-05-21T21:05:45-04:00By Emily Immer|Financial, Physician Advisor/Peer Review, Services|

Humana Launches Nationwide Value Based Cancer Care Program

As part of its effort to shift more of its business towards value-based care arrangements, Louisville-based insurer Humana has launched a national Oncology Model of Care program meant to drive better treatment of cancer patients across the country.

2019-04-16T20:23:26-04:00By Emily Immer|Financial, Physician Advisor/Peer Review, Services|

Value Based Care in America A State-by-State Review

Value-based care programs are flourishing across the U.S., with a seven-fold increase in the number of states implementing such initiatives in the past five years. That’s according to Value-Based Care in America: State-by-State, the second national study of state healthcare payment programs published by Change Healthcare.

2019-04-16T20:25:08-04:00By Emily Immer|Financial, Physician Advisor/Peer Review, Services|

Value-Based Approach Reduces Costs

Shifting from a fee-for-service health system to a value-based one is the most effective way to lower overall healthcare costs, a medical trade group wrote recently to a Senate panel.

2019-03-05T13:44:41-04:00By Emily Immer|Financial, Physician Advisor/Peer Review, Services|

AMA Survey: Prior Authorization Hurdles Lead to Adverse Events

Insurance prior authorizations for certain drugs, tests and treatments continue to burden medical practices and could negatively affect patient outcomes, according to new survey results from the American Medical Association.

2019-02-05T19:45:28-04:00By Emily Immer|Health Care Reform, Physician Advisor/Peer Review, Services|