Physician Advisor/Peer Review Archive - Page 6 of 9 - BHM Healthcare Solutions Experts in Review Services

Survey Shows Benefits of Outsourcing Physician Advisor Services

2017-12-01T13:27:23-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

Outsourcing is not a new word for healthcare. The speed of growth of outsourced services is new. Now administrative services joins the ranks of services under outsourcing consideration. A recent survey indicates providers look to outsourcing Physician Advisor complex case review and complex claims review, because they anticipate a decline in reimbursements and inpatient margins narrowing further next year. Almost a 20% growth from 2013 to 2016.

Key Components to a Great Peer Review Training Program

2017-11-30T19:08:17-04:00By BHM Marketing|Physician Advisor/Peer Review|

Peer Reviews are necessary to remove Conflict of Interest inherent in a healthcare environment by reducing the potential for the organization to make financially driven decisions when applying the Medical Necessity Criteria (MNC) to patient care.

5 Tips for Choosing Physician Advisor Services

2017-11-30T19:05:15-04:00By Eric Duchinsky|Physician Advisor/Peer Review, Services, Uncategorized|

Choosing the right Physician Advisor Services can be difficult. It’s important to look for a Physician Advisor Services that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified.

Free Webinar: Beyond Concordance Rates

2023-08-12T07:24:20-04:00By Eric Duchinsky|Physician Advisor/Peer Review, Trends, Uncategorized, Webinars|

Free Webinar: Beyond Concordance Rates: BHM’s New Innovations for Improving the Peer Review Process BHM Healthcare Solutions debuts its exciting new web-based suite of data reporting tools! BHM is at the forefront of data mining allowing clients to do a deeper dive on case data. Unlike any other reporting tool in the market today, BHM’s peer review system facilitates more data capture, data mining - analysis, reporting and review. Managing your case data more effectively will reduce costs, improve productivity, and maximize your resources.

5 Tips for Choosing a Peer Review Program

2017-11-30T19:01:47-04:00By BHM Marketing|Physician Advisor/Peer Review, Uncategorized|

Choosing the right Peer Review Program can be difficult. It’s important to look for a Peer Review Program that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified. Use these 5 tips to help you choose a Peer Review Program or use as a guide for your current vendor.

Best Practices for Lowering Fraud

2023-09-08T15:42:48-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

Building strong payer/provider relationships is critical to lowering the risk of fraud. Because the nation’s health care industry uses third-party payers such as commercial insurers and Federal and State government, the relationship between payer and provider is one that needs a lot of care and attention. From coding to physical documentation, these 4 tips are outlined by the Department of Health and Human Services as the most important ingredients to successful payer-provider relationships.

CMS Release Gold Mine of Data for Benchmarking Your Operations

2023-09-08T15:45:10-04:00By Eric Duchinsky|Big Data, Physician Advisor/Peer Review|

The Centers for Medicare & Medicaid Services (CMS) released Part 2 in a set of data that details information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The CMS believes that The Part D Prescriber PUF data will provide healthcare professionals with important information to drive change within the industry. “These data enable a wide range of analyses on the type of prescription drugs paid for under the Medicare Part D program, and on prescription drug utilization and spending generally.”

Isolate Errors Impacting Payments

2023-08-12T08:16:11-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

The medical reviews process is critical to healthcare ecosystem. The process helps protect against Medicare fraud and the many risks associated with atypical billing patterns and payments. The Social Security Act outlines very specific guidelines for reducing medical review error. Medicare contractors are used to help review data and medical records. Contractors ensure requirements for Part A and Part are in place and that claims data is reviewed for any errors. Through the collection of data and data analysis, medical reviews ensure that Medicare payments are not only met but also that they follow strict coverage, coding and medical necessity requirements.

Benefits of the Appeals Process

2023-10-12T10:50:13-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

Thanks to the Affordable Care Act (ACA) patients have the right to appeal decisions made by their providers and by the insurers. The appeals process contributes to continuous improvement and greater efficiencies for all healthcare.

Does your review process protect against conflicts of interest?

2023-09-08T15:21:31-04:00By Eric Duchinsky|Physician Advisor/Peer Review|

Peer-to-Peer and Physician Advisory Review Programs are a crucial part of driving quality improvement throughout healthcare organizations. They are key to helping organizations maintain credibility and support effective unbiased reviews. Thanks to the Affordable Care Act, consumers expect unbiased review of their care through the claims and appeals processes. Independent Review Organization have now been placed in the forefront of the healthcare industry.

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