Trends in Healthcare

Mastering Denial Management: Strategies for Efficient Reimbursement

2023-09-12T14:39:14-04:00By |Clinical Operations Improvement, Financial Analysis, Healthcare Independent Review, Trends|

Denial management involves navigating the complex web of insurance claims, reimbursement processes, and regulatory compliance to ensure that rightful reimbursements are received for services rendered. This blog aims to delve into the strategies that empower healthcare providers to crack the code of denial management, achieving optimal financial outcomes while upholding the quality of patient care.

Clinical Peer Review’s Role in Modern Performance Management

2023-03-22T15:58:59-04:00By |Clinical Analysis, Clinical Operations Improvement, Staff, Trends|

Clinical peer review in modern performance management requires a secure, easy-to-use software system. Peer reviews are a form of performance evaluation that involve feedback from colleagues within the same profession or industry. In the healthcare industry, peer reviews are commonly used to evaluate the performance of clinical staff, including physicians, nurses, and other healthcare professionals.

Prior Authorization Process Improvements

2023-02-16T18:28:24-04:00By |Payer Trends, Trends, Utilization Management|

Prior authorization is a utilization management process used by some health insurance companies for determining if the patient’s health policy covers a prescribed services, like procedures, tests, or medications, before services are rendered. While intended to control healthcare costs, prior authorizations can be a significant burden on healthcare providers and can delay patient care.

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