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4 Targets For Resource Improvement

2017-04-02T13:27:55-04:00By |Revenue Cycle Improvement, Services, Uncategorized|

Many hospitals are currently asking themselves, "How can we improve our revenue cycle in 2015?" This topic is also one many C-suite executives are facing in 2015, which is proving to be another year of vast changes. Financial departments will have to stay on top of contract management, as well as planning for shifts in how payments are received. Today, we've put together a list of 5 ways healthcare providers can reboot their revenue cycles and stay ahead of those changes that impact the bottom line.

Data Management Is Denial Management

2023-08-07T16:07:33-04:00By |Quality Improvement Programs, Revenue Cycle Improvement, Uncategorized|

You know your reimbursement process needs attention when the response to an adverse determination is to resend the exact same paperwork through the pipeline. In a few cases, the ROI on a resend appears reasonable, but peel back the band-aid and you will find a process needing attention. Understanding data management is denial management begins the healing process.

Delegation For Workers Compensation

2017-06-09T10:24:41-04:00By |Health Care Reform, IRO, Physician Advisor/Peer Review, Uncategorized|

Across the country more and more workers compensation organizations are utilizing Workers Compensation Independent Medical Reviews to keep claims on track, and to decrease unnecessary expenditures as they relate to legal proceedings. When choosing an independent medical review network ask if they offer delegation for workers compensation medical reviews. Delegation provides an opportunity for significantly lower administration expenses wile increasing the quality of reviews.

Levels Of Care Coordination

2017-12-06T16:03:01-04:00By |Managed Care, Physician Advisor/Peer Review, Services, Uncategorized|

Medical Necessity and Levels of Care (LOC) criteria are interdependent sets of objective and evidence-based health guidelines used to standardize coverage determinations, promote evidence-based practices, and support a patient’s recovery and well-being. Being such, LOC application, documentation, and accuracy plays a pivotal role in care and reimbursement.

5 Tips for Medical Directors

2023-08-07T14:25:08-04:00By |News and Events, Physician Advisor/Peer Review, Uncategorized|

Whatever the title, Medical Director, CMO, or similar, the responsibilities loom large with little relief in sight. Burnout, recruitment, and retention might be a larger concern than medical necessity criteria, case shaping, and utilization management. The end of the ACA won't likely make things easier. With that in mind, here are 5 time-saving tips for medical directors.

More Reasons Claims Are Denied: Concordance Rates

2017-04-02T13:27:56-04:00By |Uncategorized|

What if the peer reviewer is out of sync with medical necessity criteria? How would you know? Looking at concordance rates organized by individual reviewers is one way to review the reviewers performance. Concordance Rates- This rate measures of a Peer Reviewers’ decision to authorize, partially authorize, or deny and compares this decision to the care manager’s belief that the case is not meeting Medical Necessity Criteria for that level of care.

Why Claims Are Denied: One Doctor’s POV

2017-04-02T13:27:56-04:00By |Uncategorized|

Using a 3rd party, unbiased, independent peer review partner to follow medical necessity criteria and make determinations builds trust, increases engagement, and improves system relationships. Dr. Nicholas Fogelson wrote a perspective article about his experience as a peer reviewer for an independent review organization network and how the lessons apply to practicing providers.

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