Risk Adjustment Coding: Addressing Accuracy, Quality and Productivity
About the Client Organization A world-class academic healthcare system with three highly regarded hospitals, physician practices, home hospice care, and various other support services located in the Eastern U.S. Challenge The health system had previously used a single revenue cycle vendor for risk adjustment coding. With the arrival of COVID, the organization decided it needed […]
Revenue Cycle Management and Coding Services
About the Client Organization A leader in homecare, palliative, and hospice services committed to enhancing the quality and consistency of healthcare delivered at home. With locations in Florida, Illinois, Michigan, and Pennsylvania, the organization serves patients and their families across seven states. Challenge The Home Health Patient-Driven Groupings Model (PDGM), which was released on January […]
Utilization Management Services Improve Case Handling Time and Reduce Management Cost
Fortune 500 National Health and Wellness Organization
Utilization Review Solution Scales Clinical Teams and Reduces Medical Management Cost
Nations Leading Third Party Administrator
Concurrent Coding Solution Improves Quality and Eliminates Backlog
For a Level 1 Academic Trauma Center
The Key to Effective Utilization Management Better Patient Care Reduced Cost
Utilization management is commonly assumed to be a strategy payers implement to reduce healthcare cost. Although successful UM programs do result in reduced cost of claims, the focus of an effective utilization management program is improved quality of care. When utilization management programs focus on denials – prioritizing cost savings over patient care – they […]
3 Best Practices of a Successful Utilization Management Program
Effective utilization management programs are based on providing the right patient care at the right time. Outlined below are the 3 best practices employed by the most successful UM programs. 1. Clearly Define Processes, Responsibilities, And Policies A well-defined utilization review process – that clearly maps out each step in the process and the roles […]
Clinical Process Outsourcing: The Future of Healthcare
The U.S. is expected to need 1.2 million additional registered nurses by 2030 and the healthcare industry anticipates a struggle to fill those roles. Some of those struggles are compounded by a nursing educator shortage, the stress of the job due to an aging population and the pandemic, as well as nurses’ preference to work […]
Are Your Clinicians Practicing at the Peak of Their License?
We have an epidemic. While a nursing shortage grows more pressing, healthcare organizations have clinicians completing tasks that can be described as administrative or near-clinical. It’s time for clinicians to practice at the peak of their license and education. The Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health advises that healthcare teams “…need […]