Uncategorized Archives - Page 49 of 92 - BHM Healthcare Solutions

Isolate Errors Impacting Payments

August 29, 2016

The medical reviews process is critical to healthcare ecosystem. The process helps protect against Medicare fraud and the many risks associated with atypical billing patterns and payments. The Social Security Act outlines very specific guidelines for reducing medical review error. Medicare contractors are used to help review data and medical records. Contractors ensure requirements for Part A and Part are in place and that claims data is reviewed for any errors. Through the collection of data and data analysis, medical reviews ensure that Medicare payments are not only met but also that they follow strict coverage, coding and medical necessity requirements.

Case Study For Provider Success

August 26, 2016

Many healthcare organizations face financial and organization challenges due a wide array of changes in the industry. From changing legislation to shifts in the economy, organizations are forced to shift along with the industry. This rapid shift to a new healthcare emphasis on value based performance and consumer outcomes, has created even more opportunities for organizations to transform and grow.

Change can be daunting. Improvement and transition can be difficult without the right tools. This is why many organizations look for help outside their own organization. Here is how one organization rode the waves of change and come out on top.

Tough Decision: 68% Payment Now or Take a Chance on Appeal

August 24, 2016

Last year, the Centers for Medicare & Medicaid Services (CMS) paid $1.5 billion in billing settlements to one third of the nation’s hospitals. Now, CMS has released who got paid what. According to Kaiser Health News (KHN), “the settlements were a compromise to reduce a swollen backlog of disputes over what hospitals argued they were owed¹.”

Benefits of the Appeals Process

August 23, 2016

Thanks to the Affordable Care Act (ACA) patients have the right to appeal decisions made by their providers and by the insurers. The appeals process contributes to continuous improvement and greater efficiencies for all healthcare.

CMS Field Tests Impact Payers

August 17, 2016

The CMS announced the redesign of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The two phase process will start in January of 2017 and continue for 5 years. Previous Medicare Advantage requirements have not incorporated…

MCO Uncovers Efficiencies and Opportunities

August 15, 2016

A Managed Care Organization (MCO) utilizes an array of important techniques to decrease the cost of care. Transitioning to an MCO, the case study outlined here makes significant…

Spin Cycle: Tips for Understanding Revenue Cycles

August 15, 2016

When it comes to revenue cycles, the amount of processes and subtleties involved are endless. Whether small or large all these steps impact the organization’s financial standing. It’s also easy to identify areas which…

Finally Realizing the Benefits of EHR

August 10, 2016

Technology may be the answer to increasing doctor to doctor communication and eliminating avoidable medical errors. A new study published in JAMA International Medicine suggests that electronic medical records (EMR) and other important web-based tools can help decrease the occurrence of medical mishaps. The study analyzed how effective web-based tools were at enhancing communication, specifically during patient hand-offs.

Utilization Management Link to Cost Containment

August 8, 2016

Utilization management (UM) is crucial facet of the healthcare ecosystem. It ensures that healthcare systems are running efficiently and providing a standard level of care. Overall, utilization management is critical for ensuring that an organization is not only reducing denied claims, but catering to patients’ preferences and providing proper care.

Payers Find Fix For Volatile Market Changes

August 5, 2016

Payers look to contractors for help as healthcare reform continues to drive change in the industry. From cutting costs to processing claims, there is an urgent need among payers for outsourcing. Claims management services are expected to see the biggest spike in growth in the coming years¹.

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