As healthcare institutions strive to deliver excellence, Peer Review Management Services have emerged as a critical tool for ensuring consistent quality and fostering a culture of continuous improvement. This article explores the significance of peer review management services, their benefits, and how they streamline quality in healthcare organizations.
Independent Review Organizations (IROs) play a crucial role in providing unbiased and expert evaluations. This article explores the significance of Independent Review Organizations, their role in upholding trust and expertise, and how they contribute to enhancing the quality of healthcare services.
Unlocking healthcare efficiency and quality: Discover the power of utilization management. Optimize care, enhance patient safety, and reduce costs with this essential strategy. Read more to streamline healthcare delivery effectively.
Prior Authorization AI and the Future - The process of prior authorization can be time-consuming and complicated for healthcare providers.
To understand claim denials affecting reimbursement requires data. In healthcare, claim denials occur when an insurer or payer refuses to reimburse a healthcare provider for a particular medical service or treatment. Claim denials can occur for a variety of reasons, such as inaccurate or incomplete billing information, lack of medical necessity, or failure to follow the proper billing procedures.
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.
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.
The federal government hit CVS Health and Centene with lower quality scores for the health-insurance plans they sell to seniors. Star Rating scores are a big deal for health insurers, because plans that score 4 stars or higher receive bonus payments from the federal government that they can use to edge out competition by funding new health-plan benefits to attract more customers.