BHM Blog2022-12-07T11:38:10-04:00

Sharing what we learn begins here

Top At-Risk Conditions and Utilization Spikes

By |Behavioral Health Integration, Mental Health, Payer Trends, Quality Improvement Programs, Revenue Cycle Improvement, Trends, Utilization Management|

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.

Peer-to-Peer Review Pitfalls & Solutions

By |IRO, Physician Advisor/Peer Review, Services|

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.

CMS Star Ratings Major Setback for 2 Insurers

By |Readmissions, Utilization Management|

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.

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