4 Targets For Resource Improvement

2017-04-02T13:27:55-04:00By |Revenue Cycle Improvement, Services, Uncategorized|

Many hospitals are currently asking themselves, "How can we improve our revenue cycle in 2015?" This topic is also one many C-suite executives are facing in 2015, which is proving to be another year of vast changes. Financial departments will have to stay on top of contract management, as well as planning for shifts in how payments are received. Today, we've put together a list of 5 ways healthcare providers can reboot their revenue cycles and stay ahead of those changes that impact the bottom line.

Data Management Is Denial Management

2023-08-07T16:07:33-04:00By |Quality Improvement Programs, Revenue Cycle Improvement, Uncategorized|

You know your reimbursement process needs attention when the response to an adverse determination is to resend the exact same paperwork through the pipeline. In a few cases, the ROI on a resend appears reasonable, but peel back the band-aid and you will find a process needing attention. Understanding data management is denial management begins the healing process.

Delegation For Workers Compensation

2017-06-09T10:24:41-04:00By |Health Care Reform, IRO, Physician Advisor/Peer Review, Uncategorized|

Across the country more and more workers compensation organizations are utilizing Workers Compensation Independent Medical Reviews to keep claims on track, and to decrease unnecessary expenditures as they relate to legal proceedings. When choosing an independent medical review network ask if they offer delegation for workers compensation medical reviews. Delegation provides an opportunity for significantly lower administration expenses wile increasing the quality of reviews.

Levels Of Care Coordination

2017-12-06T16:03:01-04:00By |Managed Care, Physician Advisor/Peer Review, Services, Uncategorized|

Medical Necessity and Levels of Care (LOC) criteria are interdependent sets of objective and evidence-based health guidelines used to standardize coverage determinations, promote evidence-based practices, and support a patient’s recovery and well-being. Being such, LOC application, documentation, and accuracy plays a pivotal role in care and reimbursement.

5 Tips for Medical Directors

2023-08-07T14:25:08-04:00By |News and Events, Physician Advisor/Peer Review, Uncategorized|

Whatever the title, Medical Director, CMO, or similar, the responsibilities loom large with little relief in sight. Burnout, recruitment, and retention might be a larger concern than medical necessity criteria, case shaping, and utilization management. The end of the ACA won't likely make things easier. With that in mind, here are 5 time-saving tips for medical directors.

Survey Shows Benefits of Outsourcing Physician Advisor Services

2017-12-01T13:27:23-04:00By |Physician Advisor/Peer Review|

Outsourcing is not a new word for healthcare. The speed of growth of outsourced services is new. Now administrative services joins the ranks of services under outsourcing consideration. A recent survey indicates providers look to outsourcing Physician Advisor complex case review and complex claims review, because they anticipate a decline in reimbursements and inpatient margins narrowing further next year. Almost a 20% growth from 2013 to 2016.

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