5 Key Elements of the Peer Review Process

2023-10-07T09:18:48-04:00By |Clinical Operations Improvement, Physician Advisor/Peer Review, Training, URAC Accreditation, Utilization Management, Webinars|

Lately we have been talking about the important of Independent Review Organizations (IROs) and peer reviews in the healthcare ecosystem. Today we continue this discussion and delve deep into the importance of the peer review process. We know that peer reviews are a crucial part of healthcare because they hold medical professionals and organizations accountable in addition helping to build a world of trust between patient and physician. The peer review process is one that consists of high levels of property technology and superior customer service. By boosting transparency in healthcare, peer reviews have become an essential standard helping to make healthcare safer and more efficient. So let’s take a look at the 5 core building blocks of the peer review process.

5 Ways Revenue Cycle Management (RCM) Reduces Errors & Increases Revenue

2017-04-02T13:28:09-04:00By |Clinical Operations Improvement, Financial, Financial Analysis, Revenue Cycle Improvement, Services|

With new advances in the way medical information is transcribed, stored and transferred, technology has created more variables to a provider’s success than ever before. Between tangling with mountains worth of paperwork, handling claims denials and riding the learning curve of new systems like EHRs and ICD-10 coding, there can be lots of room for error and, consequently, potential revenue that slips through the cracks. Luckily, revenue cycle management systems are here to help. They can streamline a vast array of your most intensive processes — like admitting, coding, balancing budgets, billing and filing claims — in order to provide a supreme level of oversight and control. This control in turn helps you avoid common RCM problems that lead to lost revenue, profitability and productivity.

Big Data in Healthcare: 3 Infographics You Need To Read

2023-10-10T12:49:30-04:00By |Big Data, Clinical Operations Improvement, Services|

Big Data is term reserved for the larger-than-life amounts of data collected in our, now, very digital world. In the healthcare world, big data is often used to describe electronic health records (EHR) and patient data. Technology has improved our ability to collect and analyze healthcare data. With this grand opportunity for innovation and growth come questions of security and patient data safety. Read the following 3 infographics to get some insight into the world of Big Data in the healthcare industry.

10 Reasons You Need an Independent Review Organization (IRO)

2024-06-19T08:16:33-04:00By |IRO|

Many case managers look to Independent Review Organizations (IROs) to get help with decision-making and for outside perspective from a trusted source. For some, their collaboration is required. So how do you know when it’s time to start working with an IRO? Here are 10 instances which can help you better identify when its time to look for a partner.

The Road To NCQA Health Plan Accreditation

2024-07-26T08:33:04-04:00By |Accreditation, NCQA Accreditation, Services|

Are you a health plan looking into NCQA accreditation? We know that the process can be daunting and often stressful, so we’ve compiled a list of NCQA basics to help those who are pondering an NCQA accreditation. If you are a health plan who has already chosen to pursue NCQA accreditation, take a look at our blog post "NCQA Health Plan Accreditation : The Difference Between Failure and Success." For those of you just getting started let's dive into the NCQA basics, from who the NCQA is to an overview of their Health Plan accreditation levels. Hopefully this list helps jump-start your journey towards successful healthcare accreditation.

CMS Announces Meaningful Use Final Rules & Stage 3 Implementation

2017-04-02T13:28:11-04:00By |Uncategorized|

Now that the ICD-10 panic has subsided the healthcare world is focusing on something new: Meaningful Use. Despite mixed reactions from the public and congress, many of whom expressed concern about the proposed changes and rules, The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) released the final rules for the changes to Meaningful Use Stage 1 and 2, the Stage 3 requirements and the 2015 Edition Health IT Certification Criteria. The mixed reactions are born out of the reports that many healthcare providers that have yet to successfully achieve Stage 2, with “35 percent of hospitals and a small fraction of physicians” meeting the Stage 2 requirements.” If you haven’t been keeping up with the Meaningful Use news you can read some of our blog explaining meaningful use Stage 2 here. The statement from the Department of Health and Human Services (HHS) stated that the final rules and changes would hopefully “add new flexibilities for providers to make electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange that information.”

Eliminating Risk with Independent Review Organizations

2017-11-30T14:18:12-04:00By |Accreditation, IRO, Physician Advisor/Peer Review, Services|

We’ve been talking a lot lately about how and where Independent Review Organizations, or IROs, fit into denial management. The Peer Review process, which brings in an unbiased third party to help alleviate the pressure of reviewing claims, is an essential part of denial management. We’ve touched on many of the different benefits of IROs in previous blog posts, from how they affect your ROI to how they bring specialized expertise to reviews. This blog post focuses on the four main ways IROs and external reviews can help eliminate risk within your organization.

NCQA Presents HEDIS 2016 Volume 2 with Relevant ICD-10 Codes

2024-07-26T08:57:17-04:00By |Accreditation, NCQA Accreditation|

The NCQA announced on September 29, 2015 that the 2nd volume of HEDIS 2016 (The Healthcare Effectiveness Data and Information Set) would be completely ICD-10 compliant and ready for the implementation day of OCT 1. The NCQA has phased out the ICD-9 codes as per NCQA regulations and added over 73,000 ICD-10 codes, across 56 HEDIS measures. "Health plans, health data clearinghouses and health care providers will now be able to code records to comply with CMS requirements for HEDIS reporting."

ICD-10: The Countdown is Over – BHM’s Last Minute Tips

2017-12-01T15:54:20-04:00By |Clinical Operations Improvement, Financial, Organizational Analysis, Services|

October 1st is here and with it arrives ICD-10. Whether the looming implementation date of the new codes sent your organization into a state of urgency or the date felt like a non-event, ICD-10 is here. There will be a strong focus on the transition to ICD-10 in the coming months and we know it isn't going to be easy, as resources and employees get allocated to fix errors and educate staff. It's important to remember that focus and communication will be key to get through the ICD-10 era. To help make this transition less overwhelming we have complied a list of seven last minute tips to help you successfully transition to ICD-10.

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