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Monthly Archives: August 2012

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10 Predictions for the Future of Healthcare

Posted on August 31, 2012 by Linda Ringquist

Healthcare, as we know it, is changing at an explosive rate especially in conjunction with the economy as well as the introduction of the Patient Protection and Affordable Care Act (PPACA). The PPACA was enacted in 2010 and has provisions and standards which will become effective through 2015 adding to the evolution of healthcare. Additionally, the state of the economy is affecting all Americans, requiring all of us to do more with less

DPR Construction surveyed 42 leaders in the healthcare industry as to what they predicted the future holds for the healthcare industry. Following are the results of the survey which focus upon wellness, integration, and community embeddedness:

  1. There is a care shift to prevention and wellness, services which may be performed in a primary care setting or other non-hospital setting, which may shift hospital emphasis to high acuity patients and services. Hospitals may become smaller in size due to shift in scope and the treatment of fewer lower acuity patients.
  2. Healthcare systems are continuing to merge together creating fewer systems, each consisting of more facilities. This merging trend may decrease the number of not-for-profit facilities as some of these are merging with for profits. Additionally, the trend is toward physician practices becoming a part of healthcare systems rather than operating independently.
  3. Outpatient services will become more of an emphasis due to a shift toward patient centered healthcare and the creation of Medical Homes and Affordable Care Organizations, again supporting the transition to focusing upon prevention and wellness.
  4. Specialty areas will continue to focus upon the aging population and will center on services which are most profitable such as cardiac, oncology, and arthritis.
  5.  Health Information Technology will continue to become a primary interest which will require facilities to increase spending for things such as electronic medical records, telemedicine, home monitoring systems, and point of care. Increased costs may be due to implementing or upgrading these systems as well as possible facility changes to accommodate these systems and perhaps the addition of staff to implement and manage these systems.
  6. The economy will continue to be an issue. Facilities have less cash on hand necessitating the need for external funding, also calling into question the ability to repay amounts borrowed. Lending institutions are beginning to delay funding decisions making it more difficult to obtain the funding requested and in a timely manner.
  7. Renovation and re-purposing of facilities will become more important. Generally, it is much more cost effective to renovate an existing building than to start over fresh with a brand new building. The condition of the facility is something that affects patient satisfaction and is therefore an item of interest. Patients are gravitating toward state-of-the art facilities requiring each facility to “keep up with the Joneses”.
  8. There is shift toward being “green” as patients are beginning to value organizations which are actively moving toward saving operational costs through “green” measures.
  9. Delivery methods are changing in order to provide reduced costs, collaborative efforts to reduce wastes and increase efficiencies.
  10. Demographics are changing and care will need to accommodate the aging population, including both aging illnesses, increased numbers of patients, and sufficient number of physicians to treat the increased number of patients.

These predictions, along with healthcare legislation slated and pending and changes in the economy, provide additional challenges for the healthcare industry. Competitive advantage will be much more difficult to obtain.


Posted in Financial, Health Care Reform, Healthcare Prevention | Tagged Affordable Care Organizations, Healthcare, Healthcare Information Technology, Medical Home, Patient Protection and Affordable Care Act | 5 Comments

URAC IRO Accreditation and PPACA

Posted on August 30, 2012 by Linda Ringquist

What is IRO? IRO stands for Independent Review Organization

PPACA is the Patient Protection an Affordable Health Care Act which was passed in 2010 with effective dates for specific clauses spanning from 2010 to 2015.

URAC is an independent not-for-profit organization which offers national recognition and accreditation for healthcare organizations and provides a benchmark for quality and accountability.

Under the PPACA, health plans must have an established method for external reviews which must comply either with an approved State external review  or the Federal external review processes. State approved plans must have external reviews conducted by a URAC or other nationally accredited organization.

Minimum qualifications of an IRO reviewer:

  1. Peer reviewers must have expertise in the particular type of case being reviewed
  2. Peer reviewers must be credentialed (includes review of history of sanctions and any disciplinary actions
  3. Peer reviewers must attest to the fact there are no conflicts of interest for the particular case
  4. Peer reviewers must be licensed in the appropriate area
  5. Peer reviewers must be board certified

When assigning cases, IROs should have the following criteria:

  1. Criteria for determining reviewer areas of expertise (areas in which they are credentialed)
  2. Appropriate board certification
  3. Appropriate licensure
  4. Scope of licensure
  5. Professional experience associated with the specific health services, treatment or issue associated with the particular review
  6. No conflict of interest exists for the particular case

Determining medical necessity requires review of the following:

  1. Patient’s medical record
  2. Recommendations by the attending physician
  3. Current research in regard to evidence-based practice guidelines
  4. Health plans’ criteria for determining medical necessity
  5. For experimental or investigational case reviews, review will also consist of an examination of current medical research and peer-reviewed information

Why become URAC accredited for IRO services?

  1. Ensures the organization has established policies and procedures which meet national standards
  2. Ensures the organization has established policies to achieve sound business practices, quality and performance improvement
  3. Establishes a procedure for conducting standard reviews as well as expedited reviews within established time frames
  4. Establishes a method of ensuring reviews are conducted without any conflict of interests.
  5. Provides a means of establishing best practices in terms of both clinical expertise and medical necessity.
  6. Provides consumers a method to submit a complaint directly to URAC if there is an issue with an IRO or an IRO reviewer.

BHM Healthcare Solutions is healthcare management consulting firm who has attained URAC accreditation for our IRO services.  We have a state of the art physician review services portal which allows complete automation of the peer review process from providing the review information to assigning the case to physician documentation and determination to automatically letting our clients know when a case has been reviewed. Our portal provides a method for documenting that there is no conflict of interests and has federally mandated deadlines built into the system. For more information on our physician advisors services, please visit our physician advisors services webpage or call 1-888-831-1171. We look forward to assisting you. Please click on the gift box below for a free presentation on medical necessity.

Free Presentation on Medical Necessity Criteria

Click on the Gift Box above to receive a 100% free presentation on Medical Necessity Criteria as a token of our appreciation


Posted in Accreditation, Compliance, Health Care Reform, Health Insurance, Services | Tagged Affordable Care Act, Board Certified, Expedited Review, Healthcare Management Consulting, Peer Review, Physician Advisors, PPACA, Standard Review, URAC, URAC Accreditation, What is IRO | Leave a comment

Physician Advisors By Any Other Name……

Posted on August 29, 2012 by Linda Ringquist

What are physician advisors? They are physicians who review cases which have been denied based upon medical necessity. They are board certified and credentialed and/or licensed in specific areas. Some of the more common terms for physician reviews include:

  1. Physician review
  2. Physician peer review
  3. Case review
  4. Peer review
  5. Medical review
  6. Clinical review
  7. Independent review
  8. Peer to peer review
  9. IRO review

How does one go about requesting a physician review? The process begins with a medical claim which has been denied based upon medical necessity. The first step is to contact the insurance company who denied the claim and make sure they have all of the pertinent information and there is an understanding of exactly why the claim has been denied. This is the opportunity to provide any additional or missing data which may have a bearing on the case. If there still isn’t resolution to the denial, an internal review may be requested.  This entails a formal review of the case by the insurance company. If the denial is still not rectified, a request may be submitted for an external review by an independent review organization. An IRO will provide an independent unbiased review of the case and all of the supporting documentation in conjunction with the reason for denial. The decision that is issued by the IRO is the final decision and the last recourse in the appeals process. The possible decisions include

  1. Denial
  2. Partial Denial
  3. Overturned

BHM Healthcare Solutions is a company comprised of healthcare management consultants. BHM has attained URAC accreditation for our IRO services. We offer a state of the art physician portal which automates the process from start to finish. Our physicians are all board certified as well as licensed and/or credentialed and can assist you in meeting all of your IRO needs. If your organization is looking for an IRO, who is URAC accredited, please contact us at 1-888-831-1171 to setup a free consultation. Please view our physician advisor services web page for more information.


Posted in Health Insurance, Services | Tagged BHM Healthcare Solutions, Board Certified, Case Review, Clinical Review, Independent Review Organization, IRO, Medical Review, Peer Review, Peer to Peer, Physician Advisors, Physician Review | Leave a comment

Do You Need Physician Advisors?

Posted on August 28, 2012 by Linda Ringquist

BHM Healthcare Solutions (BHM) is a healthcare management consulting company which offers services including denial management, quality management, revenue cycle, continuous improvement,  physician advisors, executive recruitment, accreditation, compliance, and training. BHM recently attained URAC accreditation in IRO and PCHCH as well as URAC PCHCH Auditors Certification.

What is IRO? IRO stands for independent review organization. What is PCHCH? PCHCH stands for patient centered health care home accreditation. Both services fall under the category Physician Advisors. BHM has implemented a state of the art Physician Advisors portal which automates the process for the organization and the physician reviewers.

The portal meets all of the requirements for both IRO and PCHCH standards. All documentation is maintained in one database, including the reason for the claim denial, supporting documentation, reviewer’s notes, clinical rationale, and the final decision rendered.  Emails are automatically generated and routed to the appropriate parties for:

  1. Notification a case review has been submitted for review
  2. Notification a case review has been assigned to a physician reviewer
  3. Notification a case review has been completed by the physician
  4. Daily notifications if case reviews are due for the current day and have not yet been completed

Mandated deadlines are automatically built into the portal for both standard and expedited reviews. Cases are easily added to the system through both cut and paste processes as well as the ability to attach any supporting documentation.  All of our physician advisors are board certified and meet all of the standards set forth by URAC.

Not only does BHM provide physician advisor services, but we also can assist you with any of your accreditation needs. Are you accredited? Are you attempting to become accredited or re-accredited? Do you have a survey scheduled in the coming months? BHM has a 100% accreditation success rate for the organizations who we have provided accreditation services. Please call us today at 1-888-831-1171 if you would like to schedule a free consultation or you have any questions. We look forward to hearing from you soon.


Posted in Accreditation, Compliance, Services | Tagged BHM Healthcare Solutions, Board Certified, Case Review, Independent Review Organization, Patient Centered Health Care Home Accreditation, PCHCH, Physician Advisors, Physician Reviewers, URAC Accreditation, URAC PCHCH Auditors Certification, What is IRO | Leave a comment

The Value of CARF Accreditation

Posted on August 27, 2012 by Linda Ringquist

Original Source – CARF website

The Commission on Accreditation of Rehabilitation Facilities(CARF) was founded in 1966 and is an independent, nonprofit accreditor of health in human services in the following areas:

  1. Aging Services
  2. Behavioral Health
  3. Business and Services Management Networks
  4. Child and Youth Services
  5. Employment and Community Services
  6. Medical Rehabilitation (including DMEPOS)
  7. Opioid Treatment Program
  8. Vision Rehabilitation Services

CARF accreditation follows a certain process:

  1. Consult with a designated CARF resource specialist
  2. Conduct a self-evaluation
  3. Submit the Intent to Survey
  4. CARF invoices for the survey fee
  5. CARF selects the survey team
  6. The survey team conducts the survey
  7. CARF renders the accreditation decision
  8. Submit a Quality Improvement Plan (QIP)
  9. Submit an Annual Conformance to Quality Report (ACQR)
  10. CARF maintains contact with the service provider

The benefits provided through CARF accreditation are as follows:

  1. Assurance to persons seeking services that a provider has demonstrated conformance to internationally accepted standards.
  2. Improved communication with persons served.
  3. Person-focused standards that emphasize an integrated and individualized approach to services and outcomes.
  4. Accountability to funding sources, referral agencies, and the community
  5. Management techniques that are efficient, cost-effective, and based on outcomes and consumer satisfaction.
  6. Evidence to federal, state, provincial, and local governments of commitment to quality of programs and services that receive government funding.
  7. Guidance for responsible management and professional growth of personnel.
  8. A tool for marketing programs and services to consumers, referral sources, and third-party funders.
  9. Support from CARF through consultation, publications, conferences, training opportunities and newsletters.

CARF accreditation is difficult to achieve as are other types of accreditation. The standards are updated often which can be difficult for organizations to stay up to date. Additionally, any accreditation process is lengthy and extremely detailed. BHM Healthcare Solutions (BHM) is a healthcare management consulting firm with one of our areas of specialty being accreditation. Our CARF accreditation consultants have developed processes to assist organizations who are seeking either accreditation or re-accreditation. CARF accreditation consulting through BHM consists of the following comprehensive steps:

  1. Direction and support in writing effective policies and procedures that are in compliance with applicable accreditation standards
  2. Formation of policies to reflect the desired goals of the organization
  3. Writing of procedures manuals to reflect the activities of the organization
  4. Program creation for credentialing and privileging programs for organization staff
  5. Strategic goals for quality management and improvement activities
  6. Discussion of benchmarking and risk management strategies that can be implemented by the organization
  7. Liaison with the administrator and attorney for preparation of applicable materials
  8. Follow-up after the survey.

BHM Healthcare Solutions has achieved 100% success rate for the organizations in which we have provided accreditation assistance. Could your organization be next? For a complimentary consultation, please call 1-888-831-1171. 


Posted in Accreditation, Services | Tagged BHM Healthcare Solutions, CARF Accreditation, CARF Accreditation Consultants, CARF Accreditation Consulting, Healthcare Management Consulting, Re-Accreditation | Leave a comment

BHM Healthcare Solutions – Spotlight on Denial Management and Physician Advisor Services – Assistance from Start to Finish

Posted on August 24, 2012 by Linda Ringquist

How do you reduce health insurance claim denials? Once you have reduced your denials, how do you further enrich your denials process when one does occur?

BHM Healthcare Solutions is a healthcare management consulting firm with many areas of expertise including denials management. Our services provide assistance in not only reducing medical denials, but providing Independent Review Organization services through our physician advisors and is accredited through URAC for these IRO services.

Reducing health insurance claim denials provides an opportunity to boost the bottom line and allow the organization to concentrate on other pressing financial issues.

Our analysis and assessment process includes:

  1. Complete a chart audit to determine the reasons for the denial issuance
  2. Analyze pre-service, concurrent and post-service review protocols.
  3. Assist in the implementation of effective tracking methods.
  4. Review both national and state regulations to determine if they are affecting your denial rates.

Our implementation process includes:

  1. Detailed strategy to target the denial and appeal process focusing upon implementing improvement within the organization
  2. Implement management protocols by introducing improved technology and implementing both tracking and benchmarking procedures
  3. Create methodology to manage the appeals process
  4. Implement training for utilization review and case management staff
  5. Assist in improving relationships and terms with payers
  6. Develop tracking methods to easily review causes for denials

Our prevention process includes:

  1. Review of managed care contracts that have an impact upon claim payments
  2. Prevention of physician reviews
  3. Training programs to address denial issues
  4. Assessment of billing processes that may delay the claims process
  5. Provide a methodology to focus on denials and appeals
  6. Provide training for utilization management and case management staff

Should a denial occur and an appeal be filed, BHM can also assist with this process.

  1. BHM has a state of the art physician review portal that automates many of the review processes.
  2. BHM is accredited by URAC for our IRO (independent review organization) services enhancing our credibility and dedication to quality.
  3. BHM has board certified physician reviewers with  diverse specialties

Our physician advisor services encompass:

  1. Initial review
  2. Both standard and expedited reviews
  3. Concurrent reviews
  4. Appeal process
  5. Medical record review
  6. Clinical treatment shaping and consultations
  7. UM medical necessity review
  8. Physician advisor consultation

For more information on our denials management or physician advisor services, please visit our website https://www.bhmpc.com or call us at 1-888-831-1171. Please click on the following link to receive a free presentation on denials management http://www.bhmpc.com/denial-management-landing-page/.


Posted in Accreditation, Health Insurance, Services | Tagged BHM Healthcare Solutions, Board Certified, Expedited Review, Health Insurance Claim Denials, Healthcare Management Consulting, Physician Review, Physician Reviewers, URAC | Leave a comment

Why Oh Why Was My Medical Claim Denied?

Posted on August 23, 2012 by Linda Ringquist

What are the instances in which health insurance claim denials may be issued? What resources are available when this occurs? What are the options? These are all very good questions that deserve attention.

Some of the more common reasons for a denial to be issued include:

  1. Treatment was scheduled without prior authorization
  2. Claim was filed with missing or incorrect information
  3. Claim wasn’t filed timely
  4. The treatment wasn’t covered by the policy
  5. The procedure was deemed not medically necessary

When a claim is denied, what recourses are available?

  1. Do nothing and pay the full balance for the service performed
  2. Speak to the insurance company and ask a lot of questions and provide facts as to why you think the denial shouldn’t have been issued
  3. File an appeal to request an internal review with the insurance plan

What if these don’t work and the claim was denied on the basis of medical necessity, are there other options?

Yes, an external review may be requested through your company generally after all internal options have been exhausted. An external review is completed by an independent review organization which is not affiliated with the insurance company. Medical reviews provide an unbiased determination to analyze all of the issues surrounding the case and give the physician reviewer the opportunity to deem whether or not the procedure was medically necessary. Reviews may be requested as either standard reviews or expedited reviews. Expedited reviews are requested if there is an imminent health issue for the patient which cannot wait for the normal standard review processing time.

Independent Review Organizations (IROs) can further their credibility by becoming accredited organizations through such organization as URAC. BHM Healthcare Solutions does offer IRO services and has recently become accredited through URAC for our IRO services. We are experts in the field of accreditation and have 100% accreditation rate for our clients we have assisted. Please contact us at 1-888-831-1171 or visit our accreditation webpages if we can be of assistance to you.


Posted in Accreditation, Health Insurance, Services | Tagged BHM Healthcare Services, Expedited Review, External Review, Health Insurance Claim Denials, Medical Necessity, Medical Review, Physician Reviewer, Standard Review | 2 Comments

The Affordable Care Act and CMS Quality Framework Presentation

Posted on August 22, 2012 by Linda Ringquist

Original source is CMS website.

The Affordable Care Act is such an ominous piece of government regulations and encompasses just about every aspect of healthcare. The CMS Quality Framework is no exception. Section 3014 of the Affordable Care Act establishes a federal pre-rulemaking process for the selection of quality and efficiency measures for use in certain specific programs for use in performance reporting within the Department of Health and Human Services (HHS). This pre-rule making process includes:

  1. Making publicly available by December 1st annually, a list of measures currently under consideration by HHS for qualifying programs within the Department, including measures suggested by the public
  2. Providing the opportunity for multi-stakeholder groups to review and provide input by February 1st annually to HHES on the measures under consideration, and for HHS to consider this input
  3.  Publishing the rationale for the selection of any quality and efficiency measures that are not endorsed by the National Quality Forum
  4. Assessing the impact of endorsed quality and efficiency measures at least every three years (the first report due to the public by March 1, 2012) (CMS Quality Framework Presentation)

The priorities set forth by CMS are as follows:

  1. Making care safer by reducing harm caused in the delivery of care (Safety)
  2. Ensuring that each person and family is engaged as partners in their care (Person and Family Centered Care) which can lead to URAC Medical Home Accreditation
  3. Promoting effective communication and coordination of care (Communication and Care Coordination)
  4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease (Effective Prevention and Treatment of Illness)
  5. Working with communities to promote wide use of best practices to enable health living (Best Practices for Healthy Living)
  6. Making quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models (Affordable Care)

According to the March 1, 2012 report, following are the programs which have been implemented and are currently being tracked and monitored for improvement:

  1. Hospital Inpatient Quality Reporting (Hospital IQR)
  2. Hospital Outpatient Quality Reporting (Hospital OQR)
  3. Physician Quality Reporting System (PQRS)
  4. Nursing Home (NH)
  5. Home Health (HH)
  6. End-Stage Renal Disease (ERSD)
  7. Medicare Part C (Part C)
  8. Medicare Part D (Part D)

The full report can be viewed at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Downloads/NationalImpactAssessmentofQualityMeasuresFINAL.pdf

The report also indicates quality measures which are either in the development or early implementation phases and will more than likely be included in the March 2015 report in terms of trending and results:

  1. Hospice Quality Reporting
  2. Ambulatory Surgery Center Quality Reporting
  3. Prospective Payment System – Exempt Cancer Hospital Quality Reporting
  4. Inpatient Rehabilitation Facility Quality Reporting
  5. Long-Term Care Hospital Quality Reporting
  6. Hospital Value-Based Purchasing
  7. Inpatient Psychiatric Facility Quality Reporting
  8. Electronic Prescribing Quality Reporting
  9. Medicare and Medicaid Electronic Health Record Incentive Program for Eligible Professionals
  10. Medicare and Medicaid Electronic Health Record Incentive Program for Hospitals and Critical Access Hospitals
  11. Medicare Shared Savings Program
  12. Medicare Physician Feedback/Value-Based Modifier Program
  13. Children’s Health Insurance Program Reauthorization Act Quality Reporting
  14. Health Insurance Exchange Quality Reporting
  15. Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Audit

 

 

 

 


Posted in Health Care Reform, Quality Improvement Programs | Tagged Affordable Care Act, CMS Quality Framework, CMS Quality Framework Presentation, Patient and Family Centered Care, Quality, URAC, URAC Medical Home Accreditation | Leave a comment

The Value of Accreditation

Posted on August 21, 2012 by Linda Ringquist

Accreditation is a hot topic in healthcare, but what does accreditation really mean? Accreditation is one of the highest honors that can be awarded in healthcare. It means that your organization values and strives to meet and optimally exceed standards for quality and excellence. An accredited organization provides an additional level of comfort for patients who have an ever-expanding choice of providers.

The public is focused on quality patient care and if given a choice between accredited and non-accredited (all things being equal) will generally choose an accredited organization. They want to receive the best possible care from the time of scheduling/registering for appointments to discharge and follow-up after the appointment or procedure. Patients want to feel special like they are the only one in the facility. They want to be informed of every step along the way, be able to ask questions, and be involved in decisions surrounding their care. Patients want not only excellent healthcare, but want to visit a facility that is clean and maintained. Any phase of the visit can provide a negative taste for the entire experience such as floors that aren’t clean, trash that isn’t picked up, food that is not cooked or served properly. It is the little things that can make a difference in patient satisfaction scores.

Accreditation takes all of these items into account and strives to make the entire experience pleasant for the patient. There are several regulatory agencies which have created specific standards of excellence and accreditation for those organizations that meet or exceed those standards. URAC accreditation, NCQA accreditation, and TJC accreditation are highly coveted and sought after accreditation organizations. They have rigorous standards and have many different certification and accreditation programs. Some of the benefits of accreditation in addition to those already mentioned are:

  1. Helps organize and strengthen patient safety efforts
  2. Strengthens community confidence in the quality and safety of care, treatment and services
  3. Provides a competitive edge in the marketplace
  4. Improves risk management and risk reduction
  5. May reduce liability insurance costs
  6. Provides education to improve business operations
  7. Provides professional advice and counsel, enhancing staff education
  8. Provides a customized, intensive review
  9. Enhances staff recruitment and development
  10. Provides deeming authority for Medicare certification
  11. Recognized by insurers and other third parties
  12. Provides a framework for organizational structure and management
  13. May fulfill regulatory requirements in selected states
  14. Provides tools for accredited organizations

As mentioned, it can be a rigorous process to obtain accreditation. BHM Healthcare Solutions is one of the top healthcare management consulting firms in the country. Our health accreditation consultants are top notch and can assist you in your accreditation or re-accreditation processes. We will complete a desk review of your policies and determine the steps required to meet all of the necessary standards and stand proud with you when you achieve accreditation. We have a 100% accreditation rate for those organizations we have assisted. Call us today at 1-888-831-1171. Please visit http://www.bhmpc.com/ and view all of our accreditation services. We are here to help.

 


Posted in Accreditation, Quality Improvement Programs, Services | Tagged BHM Healthcare Solutions, Healthcare Accreditation Consultants, Healthcare Management Consulting, NCQA Accreditation, TJC Accreditation, URAC, URAC Accreditation | Leave a comment

Part 4 – What is PCHCH? NCQA’s PCHCH Accreditation

Posted on August 20, 2012 by Linda Ringquist

From Part 1 of our series, PCHCH stands for Patient Centered Health Care Home Accreditation. It is also sometimes referred to as Medical Home Accreditation. It is one of the latest health care models that places the consumer/patient at the center of health care decisions. It provides a collaborative effort between health care providers, patients, and patient’s families to discuss the pros and cons associated with potential procedures and outcomes.

Part 2 of our series provided enlightenment on URAC’s PCHCH program, including PCHCH as well as URAC PCHCH Auditors Certification (sometimes referred to as URAC Medical Home Accreditation).

In part 3, we reviewed the PCHCH certification program which is specific to The Joint Commission.

Part 4 we focus on NCQA’s PCHCH program. The official title is NCQA’s Patient-Centered Medical Home (PCMH 2011). This program is aimed toward the primary care setting. The plan gives practice information about organizing care around the patients, working in teams and coordinating and tracking care over time. There are 6 main elements to NCQA’s PCHCH recognition:

  1. Access and continuity – provide team-based care with access and advice during and after hours and patient/family information about medical home
  2. Identify and manage patient populations – acquire and use data for care of the practice’s population
  3. Plan and manage care – use evidence-based guidelines for preventative, acute and chronic care management for chronic, frequent and behavior-based conditions
  4. Self-care – support patient and family in self-care with information, tools and community resources
  5. Track and coordinate care – track and coordinate tests, referrals and transitions of care

In order to become PCMH recognized, all six elements must be passed with a score of at least 50% on each element.

BHM Healthcare Solutions is a healthcare management consulting company with a broad range of services. One of those services is accreditation. NCQA accreditation can be difficult to obtain. Our NCQA consultants are experts on all of the nuances of accreditation. We have a 100% success rate for all of our clients whom we have assisted in the quest to obtain accreditation. For more information, please visit our accreditation webpage or call 1-888-831-1171.

 

 


Posted in Accreditation, Learning Series, Services | Tagged BHM Healthcare Solutions, Healthcare Management Consulting, NCQA Accreditation, NCQA Consultant, Patient Centered Health Care Home Accreditation, URAC Medical Home Accreditation, URAC PCHCH Auditors Certification | Leave a comment

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BHM Healthcare Solutions
Healthcare Management and Consulting Firm Improving Financial &
Operational Performance of Health Care Enterprises
Suite 102, 1033 Corporate Square Drive St. Louis, MO 63132
888-831-1171 Office, 888-818-2425 Fax
email: results@bhmpc.com

 


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