Choosing the right Peer Review Program can be difficult. It’s important to look for a Peer Review Program that distinguishes itself through quality work, ongoing training, full compliance, and the latest technology. You want to trust the organization you choose and make sure they are industry certified. Use these 5 tips to help you choose a Peer Review Program or use as a guide for your current vendor.
According to the Centers for Disease Control, an estimated $25 billion of U.S. healthcare costs was attributed to the abuse of painkillers—otherwise known as opioids. Up to 36 million people worldwide struggle with opioid addiction. It is a real concern for health plans and the pharmacies and providers under their umbrella. How can your health plan read the warning signs within provider networks to prevent this addiction from the start and minimize the risk and cost impact to your organization?
According to a recent Revive Health Inforgraphic, the percentage of healthcare leaders who have trust in any payer is eroding over time. Revive Health conducted a survey where they targeted 201 hospital leaders who “negotiate and/or approve managed care contracts with national health insurance companies. “
The opioid epidemic sweeping the country is still in full force. As opioid dependency marks one of biggest challenges healthcare providers, payers, it has become a critical focus for everyone in the healthcare ecosystem. A recent study, reported by Kaiser Health News, found that the United States saw a 1300% spike in “spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.”
Building strong payer/provider relationships is critical to lowering the risk of fraud. Because the nation’s health care industry uses third-party payers such as commercial insurers and Federal and State government, the relationship between payer and provider is one that needs a lot of care and attention. From coding to physical documentation, these 4 tips are outlined by the Department of Health and Human Services as the most important ingredients to successful payer-provider relationships.
HEDIS is a tool used by 90% of America’s Health Plans to gauge performance on crucial aspects of care and service. By standardizing the way health plans collect, analyze, and report performance information and data, HEDIS creates an equal playing field for all health plans (who use HEDIS) to be compared. The tool is also used by health plans to learn which area they can improve in. On the other end, employers, consultants, and patients use HEDIS data to help them select the best health plan for their needs.
The Centers for Medicare & Medicaid Services (CMS) released Part 2 in a set of data that details information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The CMS believes that The Part D Prescriber PUF data will provide healthcare professionals with important information to drive change within the industry. “These data enable a wide range of analyses on the type of prescription drugs paid for under the Medicare Part D program, and on prescription drug utilization and spending generally.”
The 2009 American Recovery and Reinvestment Act set up established payment adjustments under Medicare for eligible hospitals, who are not users of Certified Electronic Health Record Technology (CEHRT). According the CMS, hospitals that don’t demonstrate meaningful use for an EHR reporting “period associated with a payment adjustment year will receive reduced Medicare payments for that year.
The shift to accountable care and value-based payment models is taking healthcare by storm. Accountable Care Organizations (ACOs), which focus on shared accountability and quality improvement, are becoming a popular model for many healthcare organizations looking to move forward in the new era of healthcare. Around 7.7 million Medicare beneficiaries receive care from an ACO. This has resulted in better care for the beneficiaries and a reduction in total costs.
Three data security stories caught my eye, this month.
August 3: Banner Health suffers year’s largest data breach; 3.7M affected
August 15: Bon Secours vendor breach affects 655k patients
August 22: OCR to investigate more breaches affecting 500 or fewer individuals
As much as the details differ between the three stories, one worry comes true: cyber security threats are growing.
Copyright 2025 © All rights Reserved.
