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ICD-10 impacts to providers – Scheduling : Preauthorizations and Certifications

Does your organization have Standard Operating Procedures (SOPs) that use ICD-9 CM diagnosis or ICD-9 procedure code information? If so, those procedures and systems need to be evaluated as part of the ICD-10 Impact Assessment.

Out of Network Claims Cost Containment Strategy : Don’t Damage MLR

Since most of the cost containment and settlement solutions vendors do charge the plan, this actually works against the health plan's ability to manage their expenses and comply with regulations. Health plans should look to solutions that support the MLR calculation and regulations, and maximize the speed and the amount of reimbursement to the provider.

By | 2017-05-04T04:06:48+00:00 August 14th, 2012|CMS, ICD-10, Medical Loss Ratio|0 Comments