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.
Artificial Intelligence (AI) is rapidly transforming the healthcare industry, with the potential to revolutionize patient care and improve clinical outcomes. Over the next three years, we can expect to see AI have a tangible impact on healthcare in several ways.
Unplanned hospital readmissions occur when a patient is discharged from a hospital and then returns to the hospital within a certain time frame due to an unplanned medical issue. These readmissions can be costly for both the patient and the healthcare system. To reduce the number of unplanned hospital readmissions
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.
No Surprises Act (NSA) protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
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.
National Survey on Drug Use and Health Released by the U.S. Department of Health and Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA), which shows how people living in America reported about their experience with mental health conditions, substance use, and pursuit of treatment in 2021.
A Peer-to-Peer Review is a conversation between two healthcare professionals, usually licensed doctors, over the phone discussing a patient’s case. The Peer-to-Peer (P2P) process is used to explain or clarify something the clinical record cannot convey clearly. The core of a P2P call basically focuses on matching medical necessity criteria with reimbursement criteria.
Hospital Safety Grades released, by the Leapfrog Group, a national nonprofit watchdog organization that advances patient safety in hospitals, the fall 2022 results.
Avoiding HIPAA violations goes beyond air tight technical system controls. Often the leaks and violations come through the human elements of healthcare operations.
Copyright 2025 © All rights Reserved.
