Dr. Jagadeesha G S

Exploring the Nuances of Healthcare Prior Authorizations To a layman, healthcare policies may seem complex and often befuddling. One such aspect that healthcare providers deal with on a daily basis is "Prior Authorization" (PA). With three hip replacements and years of experience in healthcare revenue cycles, I can assure you that understanding the pasterns of PA is not as daunting as it seems. Patient's health plans set stringent standards for hospital services that need to be met with satisfactory clinical documentation. These documents provide test results, plans of care, and justifications for the procedures. Thus, providing a transparent overview of the care provided so far and the reasons for choosing certain treatment alternatives over others. A common reason for a PA denial is the unavailability or lack of clinical documentation or prerequisites. Health plans often have criteria demanding clinical prerequisites before allowing a more invasive or costly procedure. The rationale behind this approach is not only financial considerations for the patient and health insurance but also to ensure optimal patient care. To exemplify, consider a health plan that necessitates physical therapy for back pain before contemplating a surgical intervention. Not only does it bring financial relief for the health plan but also definitely benefits the patient. Who would like to bear the pain, stress, and cost of a back surgery if the same outcome can be achieved through an outpatient non-invasive course of care? Coming to the payment aspect, it gets a tad tricky. Submitting a PA requires the patient’s diagnosis code and accurate procedure details, in term of ICD-10 codes and CPT codes. A mismatch between the information sent for PA and the information listed on the medical claim, usually due to coding errors, may lead to payment denial. There are ways to smoothens this rocky journey for providers, patients, and staff: · Conduct quarterly chart audits by hiring an external company. · Engage a certified coder. · Make the clinical staff or certified coder handle the prior authorizations. · Ensure your revenue cycle team persistently follows up with insurance companies. Balancing healthcare service delivery with administrative necessities can be a hassle. That's where we come to help. Our extended professional staff can support your Healthcare Business operations round-the-clock for Clinical Customer Service, Prior Authorizations, Pharmacy Coding, Billing, and Rejections. To enlist our services, please mail us at info@staffingly.com or call us anytime, we're available 24/7 at (800) 489-5877. You can also visit our website https://staffingly.com/. We guarantee a 70% reduction in Staffing Costs! #priorauthorization #healthcareprovider #healthcare #patientcare #insuranceclaims #healthcareservices

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Hear how one client leveraged the advanced business rules in TriZetto® Clinical CareAdvance® to automate care management, which allowed clinicians to spend more time on medical review and make care decisions faster. #Healthcare #Payers #Automation #UtilizationManagement Cognizant https://cogniz.at/3vB0m9m

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Hear how one client leveraged the advanced business rules in TriZetto® Clinical CareAdvance® to automate care management, which allowed clinicians to spend more time on medical review and make care decisions faster. #Healthcare #Payers #Automation #UtilizationManagement Cognizant https://cogniz.at/3UnuFZd

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At LateralCare, we envision a future where healthcare organizations can seamlessly integrate advanced technologies and human expertise to optimize productivity and accuracy. alai, our flagship solution, is designed to revolutionize RCM through the power of generative AI. alai is not just another software; it is a comprehensive, easy-to-adopt solution that breaks down silos and unifies systems and processes. By leveraging the latest AI technology, alai ensures that healthcare organizations can streamline their revenue cycles, reduce inefficiencies, and ultimately, recognize revenue more effectively and promptly. Are you ready to transform your Revenue Cycle Management and embrace the future of healthcare? Visit www.lateralcare.com to learn more about alai or set up a call with our team today. #alaibyLateralCare #RevenueCycleManagement #Healthcare #GenAi #Revenueintegrity #Revenuerecognition #ContractManagement #LateralCare

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The prior authorization process stands as one of the most intricate and resource-intensive tasks faced by healthcare providers today. It has been a pervasive issue in the industry for years, and there has not been much collaboration or headway made to make this process smoother for patients, providers or payers. Read our blog "4 Ways to Streamline the Prior Authorization Process" for tips to improve your processes: https://hubs.ly/Q02vpNNx0 #PriorAuthorization #Blog

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Effective Radiology RCM Strategies in an Evolving Environment! Check out now: https://lnkd.in/gjVKJCSs #Allzonems #allzonemanagementservices #radiology #RCM #healthcaremanagement #medicalbilling #healthcarefinance #RadiologySuccess #strategies #revenuecyclemanagement #healthcareinnovation #healthcare #FridayMotivation

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Although slow at first, offshoring in healthcare is now gaining momentum. Revenue cycle managers and leaders acknowledge its immediate advantages, tapping into external expertise to streamline operations and mitigate revenue loss. Yet, misconceptions linger. Uncover the reality behind offshoring RCM with AGS Health as we debunk three common myths. Whether it's worries about quality, security, or communication, our blog offers invaluable insights to empower your decision-making. Don't miss the chance to enhance your RCM operations—read more here: https://hubs.la/Q02xNC7G0

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Hospitals' administrative costs are soaring. The American Hospital Association blames commercial payers, including Medicare Advantage and Medicaid, for burdening hospitals with excessive paperwork. Health Prime can manage your RCM, streamline processes, optimize your practice, and let you focus on patients, not paperwork. Read the whole article: https://lnkd.in/gRR6NCNy Contact us today and improve your revenue for decades of success: https://lnkd.in/eBnfXYM9 #practiceoptimization #revenuecyclemanagement #medicalbilling #healthcarecosts

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Our Chief Delivery Officer, Sumit Kumar, shares his 'Thryvian Take' on this blog: https://lnkd.in/g435EK9Z that appeared on healthleadersmedia.com. Building Trust in Healthcare: Enhancing the Patient Experience Healthcare has focused on clinical outcomes for decades, but that's changing. Today, 85% of healthcare CEOs prioritize delivering an exceptional patient experience. What's driving this shift? Experts predict that by 2025, patients will make healthcare choices based on the quality of their experience. This means organizations must accelerate their transformation efforts. Those who leverage technology to enhance patient engagement and personalize care will lead the way. Where to Begin Many organizations already view patients as customers. The next step is to maximize technology investments. Patient portals are a good starting point, offering features like appointment scheduling and secure communication with care teams. However, organizations should explore chatbots, machine learning, and AI to stay ahead. Partnerships and Learning from Others This is a pivotal moment for healthcare organizations. It's time to embrace agility and learn from the successes and missteps of our competitors. As we embark on the journey of implementing new technologies, our focus should be on personalization and convenience, two pillars that will shape the future of patient experience in healthcare. IT Leaders, Step Up As IT professionals, we hold the key to a profound transformation in healthcare. Our role is not just about implementing technologies but also about shaping the way patients engage with healthcare. By choosing and implementing the right technologies and strategies, we can create exceptional experiences that not only improve outcomes but also build loyalty, setting our organizations apart in this patient-centric era. #healthtech #digitalhealth #patientexperience #customerexperience

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Is your healthcare organization lagging on compliance? Delivering exceptional patient care is paramount, but ensuring adherence to regulations is equally crucial. Here's where a comprehensive checklist comes in handy! Mindbowser offers a roadmap to navigate the complexities of healthcare compliance. ✅ Read this blog and Stay Compliant with these pointers! #healthcare #healthcarecompliance #HIPAA #mindbowser

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🌟 Celebrating India's Legacy of Innovation 🌟 India's history is rich with innovation, spanning ancient discoveries to modern breakthroughs. Let's shine a spotlight on some remarkable contributions: 🔬 Dr. Navin Khanna: Pioneering the fight against mosquito-borne diseases with the "Dengue Day 1" screening test, saving lives with rapid diagnostics. 🌿 Tejas Sidnal: Championing sustainable architecture and biomimicry, showing how creativity and eco-consciousness can blend for positive change. 💡 Frugal Innovations: Ingenious solutions improving everyday life, from flood-crossing bicycles to solar-powered hearing aids, showcasing resourcefulness and accessibility. 🌐 Historical Contributions: India's ancient civilization gifted the world with zero, Ayurveda, yoga, and more, shaping global mathematics, health, and culture. 🎓 Innovations by IITians: The brilliant minds of Indian Institutes of Technology (IITs) continue to innovate, from zero-energy villas to eco-friendly packaging, driving sustainable progress. India's legacy of innovation is an inspiration, shaping the world's past, present, and future. Let's celebrate and continue this tradition of brilliance! 💡🇮🇳 #Innovation #IndiaPride #SudheerSlice

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🎉 Telangana Formation Day: Celebrating Culture, Heritage, and Progress🌄 On June 2nd, we celebrate Telangana Formation Day, marking the birth of our vibrant state in 2014 after a long struggle for statehood. Known for its rich culture, historical heritage, and warm hospitality, Telangana has made significant strides in development and progress. Historical and Cultural Heritage Telangana is home to iconic landmarks like the Charminar in Hyderabad and the serene Warangal Fort, symbols of our state's grandeur and rich history. Honoring Our Heroes Konda Laxman Bapuji: A 97-year-old freedom fighter who played a significant role in the statehood movement. K. Chandrashekar Rao (KCR): The influential leader and first Chief Minister of Telangana, whose relentless efforts led to the state's creation. Remarkable Growth Telangana has witnessed impressive growth across various sectors: Economic Growth: The Gross State Domestic Product (GSDP) has grown threefold in the last decade, with an average growth rate of 12.7%, surpassing the national average. Infrastructure Development: Significant infrastructure development Industrial Growth: Hyderabad has become a hub for IT companies, earning the nickname "Cyberabad." Contribution to India’s Progress Telangana’s consistent growth has positioned it as a key driver of India’s economic progress, contributing significantly to the national GDP. As we celebrate Telangana Formation Day, let us come together as proud Telalginite's to honor our unity, diversity, and progress. Happy Telangana Formation Day! 🌟🚀🌄 #TelanganaFormationDay #ProudTelanganite #CelebrateTelangana #TelanganaPride

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Top priorities for healthcare executives today... Stabilizing the revenue cycle and cash collection in addition to ensuring adequate cash flow. With cash being king, many organizations are turning to technologies like artificial intelligence to improve clinical documentation and enhance revenue integrity. Ensuring that clinical documentation is complete and accurate can reduce payer denials, improve financial stability, and benefit hospitals and health systems in other important ways. In a recent article published by Becker's Healthcare, Senior VP Geoff New with CorroHealth gives his insight on best practices for deploying technologies that improve clinical documentation. Read more here:

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Unlock the powerful advantages of Faster Access to Patient Information! Learn how participation in HIEs can streamline record access, reducing wait times from days to mere minutes, and enabling faster, more informed decision-making. Learn more: https://zurl.co/y4eY #SDHC #HIE #FasterAccess #MedicalRecords #DecisionMaking #EmpoweredPatients

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Propel Your 2024 Health Goals with Proactive Risk Adjustment & Quality Solutions At Focus Care, we are dedicated to guiding health plans through the complexities of the healthcare landscape to achieve optimum performance. With our deep expertise in Risk & Quality Assessments (HRAs), we tailor solutions that directly impact your bottom line and quality metrics. Here’s what we offer: 1. Early Revenue Optimization: By partnering with us, you can optimize your Risk Adjustment Factor (RAF) scores early and secure January 2025 payments. This not only enhances your cash flow but also positions you ahead of the typical mid-year adjustments in July 2025. 2. Maximizing Prospective Efforts: Leverage our specialized knowledge to bolster your 2024 initiatives, reducing the need for costly retrospective reviews, and manageable healthcare expenditures, and improving your mid-year RAF adjustments for 2025. This strategic approach minimizes missed opportunities and drives significant cost savings. 3. Comprehensive Performance Assessments: We provide thorough evaluations of your mid-year payments prospective and retrospective activities, enhancing ROI, KPIs, and overall MLR performance. Our expertise includes navigating the latest regulatory requirements, and ensuring that your organization remains compliant while maximizing outcomes. We are eager to demonstrate how our strategic intervention can make a significant difference in your operational and financial health,in addition to your member’s health. Please feel free to reach out at your earliest convenience to schedule a detailed discussion about your specific needs and how we can address them. Greg Deranian, MBA Vice President of Business Development Focus Care, Inc 781-376-6938 gderanian@focuscares.com

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In the fast-paced healthcare world, standardized medical records are vital for improving patient care, streamlining operations, and enhancing Revenue Cycle Management (RCM). Eternity Healthcare is leading this transformation with innovative solutions. Here are seven key benefits of standardization: 🔷 Interoperability: Seamless data exchange for comprehensive patient information. 🔷 Quality of Care: Informed decisions with accurate, up-to-date records. 🔷 Efficiency: Streamlined workflows and automated RCM processes. 🔷 Compliance: Adherence to regulations with robust security measures. 🔷 Cost Savings: Eliminate redundancies and reduce overhead. 🔷 Patient Engagement: Empower patients in their healthcare journey. 🔷 Innovation: Leverage AI, analytics, and telehealth for continuous improvement. Eternity Healthcare is committed to driving standardization, empowering providers with the tools and expertise needed to thrive in a data-driven healthcare landscape. Together, we can redefine healthcare delivery and drive better outcomes for all. #HealthcareInnovation #RCM #PatientCare #HealthcareStandardization #EternityHealthcare #Interoperability #Efficiency #Compliance #PatientEngagement #AIinHealthcare #HealthTech #FutureOfHealthcare

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Explore the evolving landscape of Healthcare Revenue Cycle Management, uncovering advanced solutions like AdvancedMD and the pivotal role of EHRs in 2024. Read More: 👉 https://lnkd.in/eRXjYqj4 #practolytics #coding #revenuecycle #advancedmd #rcm #ehrs #revenuecycle #ushealthcare #compliance #streamlinedservices #outsourcing #woundcare #care #medicalbilling

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Ever wondered why MBA suits are taking over independent medical practices? 🤔 Join G. Bai and us as we unpack the shift from medical degrees to financial expertise in today's evolving healthcare landscape. 💼💉https://zurl.co/1Hnb #HealthcareIndustry #FinanceInHealthcare

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