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.
BHM Healthcare Solutions, Inc., (BHM), a leader in medical and behavioral health review services and healthcare analytics, announces the retirement of Jean Neiner, President and CEO, effective December 1, 2022. With this change, we are excited to announce that Eric Rosenberg will move into the position of President and CEO.
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.
Data Collection is key. Healthcare now relies on increasingly large amounts of data for maximizing both artificial intelligence (AI) and revenue cycle management (RCM) systems. BHM Healthcare Solutions understands the value of data in getting healthcare organizations to next-gen analytics.
More than 25 years after the first federal mental health parity protections were put in place, adequate coverage for behavioral health (BH) care, including both mental health and substance use conditions, remains elusive for many consumers with health insurance.
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.