Revenue Cycle Improvement

Enhancing Collaboration in Medical Necessity Criteria

2024-02-07T08:08:12-04:00By |Care Coordination, Clinical Operations Improvement, Healthcare Independent Review, Operational Analysis, Revenue Cycle Improvement, Uncategorized|

Collaboration between healthcare providers and payers is instrumental in navigating the complexities of medical necessity criteria. By fostering a cooperative environment, both parties can work together to ensure that medical decisions align with the best interests of the patient.

Strengthening Care Through Physician Peer-to-Peer Reviews

2023-09-28T15:47:51-04:00By |Physician Advisor/Peer Review, Readmissions, Revenue Cycle Improvement, Staff, Utilization Management|

The healthcare industry has embraced a collaborative approach that is gaining significant traction—physician peer-to-peer reviews. In this comprehensive exploration, we will delve into the significance of physician peer-to-peer reviews, their role in enhancing healthcare, and how they strengthen the bonds within the medical community.

Physician Advisor Reviews Improve Patient Outcomes

2023-10-31T14:19:34-04:00By |Physician Advisor/Peer Review, Readmissions, Revenue Cycle Improvement|

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.

Understand Claim Denials Affecting Reimbursement in Healthcare

2024-02-07T07:52:10-04:00By |Healthcare Independent Review, IRO, Operational Analysis, Physician Advisor/Peer Review, Revenue Cycle Improvement, Utilization Management|

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 Streamlines RCM

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

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.

Top At-Risk Conditions and Utilization Spikes

2023-01-12T11:12:16-04:00By |Behavioral Health Integration, Mental Health, Payer Trends, Quality Improvement Programs, Revenue Cycle Improvement, Trends, Utilization Management|

Top At-Risk Conditions and utilization spikes that healthcare leaders and stakeholders across the industry must prepare to proactively address in the upcoming year highlight the recently released, 2023 State of Health – In The Aftermath Report. The report also presents predictive findings and explores the top contributing factors of many utilization increases.

AMA Passes Augmented Intelligence Policy

2018-07-10T16:18:47-04:00By |Financial, Financial Analysis, Health Insurance, Revenue Cycle Improvement, Trends, Uncategorized|

The American Medical Association passed its first policy addressing augmented intelligence in the healthcare industry during its annual meeting in Chicago, which ran June 7 to June 13. The policy suggests tasks for the AMA to address regarding the use of AI in healthcare, with a focus on encouraging healthcare stakeholders and federal policymakers to prioritize "user-centered design." The initiative builds on a proposed a "baseline policy" the association laid out in a May report to its board of trustees.

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