Our journey, from the conception of a compliance strategy for our company, to developing a full-fledged culture and integrating it completely with operations might be of some value to others. Let me share a little of what the journey was like. It was circa 2004 that I asked a known professional who had audited charts...
Utilization management (UM), care management, control of spiraling costs, care coordination: these are all the words we hear regularly these days with the advent of accountable care and increased enrollment in managed care plans across the country. But how to manage patient care and optimize costs without withholding care? That is the challenge. To my...
As premiums continue to be reduced, Health Plans, IPAs, MSOs, and medical groups must have plans in place that ensure an accurate RAF score. To obtain these, healthcare organizations must not only recapture the enrollee’s prevalent conditions but compliantly report clinical conditions as they appear. Several organizations have been “playing with numbers” to project future...
