Physician Advisory Committees

September 29, 2015

Allowing Physicians to Take the Reins of Leadership and Shape the Future of Healthcare As the soldiers on the ground and in the patient rooms, physicians can best discover and discard healthcare waste while simultaneously implementing programs to improve patient care. While many remain comfortable only in the patient...

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Physician Behavior Pattern Detection for Fraud, Abuse, and Waste in Healthcare

September 22, 2015

A Predictive Intelligence Approach to Lowering Healthcare Costs In 2011, The National Healthcare Anti-Fraud Association (NHCAA) estimated an average of 3 percent to 10 percent of healthcare spending is lost because of fraud – which includes non-rendered services, upcoding, unbundling, mischaracterization, unnecessary medical services and kickbacks.1 That’s up to $230...

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A Cost-Saving, Physician-Friendly Alternative for Prior Authorization

September 15, 2015

Improving Outcomes and Reducing Costs with a Non-Denial Model Requiring prior authorization for medical diagnostic testing and procedures provides one of the only captive periods when a physician can be engaged with the payer and its utilization management services to determine the most appropriate, evidence-based care that their patients...

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Imaging Abuse: Diagnosis and Treatment

May 8, 2015

Through involvement in the last step of HealthHelp’s three-tier radiology benefit management (RBM) process over the past four years, Jeffrey D. Robinson, M.D, radiologist, has unique insight into imaging abuse. After conducting more than 30,000 peer-to-peer telephone consultations, he concludes that providers’ inappropriate requests for imaging studies are often...

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HealthHelp Programs Qualify Under the Medical Loss Ratio (MLR) Requirements

April 13, 2015

By: Cherrill Farnsworth, President and CEO, HealthHelp Updated April 2015 Purpose Educate the health-insurance industry on the Medical Loss Ratio regulations and its overall impact. Reduce confusion in the health-insurance market by clearly outlining criteria and requirements of the Medical Loss Ratio regulations. Identify how HealthHelp’s programs fall into the...

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