Demystifying Medicare Advantage Plans

Medicare Advantage Plan, medical necessity review, prior authorization, medical necessity criteria

Medicare Advantage plans are a popular alternative to Original Medicare for many seniors who want more coverage and flexibility. But what exactly are Medicare Advantage plans and how do they work?

Unveiling the Truth: The Power of Healthcare Auditing

Healthcare Auditing, URAC Accreditation Consulting

Healthcare auditing plays a crucial role in ensuring the delivery of quality care and adherence to standards within healthcare organizations. By systematically assessing performance, healthcare audits provide valuable insights into areas of success and areas that require improvement. Let’s explore the importance of healthcare auditing in more detail.

Physician Advisor Reviews Improve Patient Outcomes

Physician advisor

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.

Payviders and Their Growing Impact on Healthcare

payvider, utilization management, payer

Payviders offer both insurance coverage and healthcare services to patients. This concept is a relatively new development in the healthcare industry, and it has the potential to significantly impact the way that healthcare is delivered and financed.