IRO

 

Beyond Uber and Postmates: How Your Organization Can Benefit From Gig Economy Principles

By Keith Saunders The concept of the gig economy is reflective of the paradigm-shifting changes which are affecting the overall economy.  The forces of connectivity, automation, and the deployment of artificial intelligence are all changing not only what we work on but also how we work. In the past, organizations created their workforce and accompanying […]
Posted in IRO

Why Accreditation Makes a Difference

By Janice Bohan Many organizations struggle with deciding whether or not to invest time and money into pursuing certification of their quality management system. Will the return be worth the investment? Is it a catalyst for positive change within an organization? In the Independent Review Organization (IRO) world, ISO-9001 Certification and URAC Internal & External […]
Posted in IRO

5 Ways to Tackle an Appeals Backlog

by Jim Bobeck Government and commercial backlogs may occur quickly and without warning. A sudden spike of appeals can arise due to a seemingly innocuous change in government regulations. Adjustments to payment criteria for health services can send health plans, TPAs, ACOs, and PHOs into a claims tsunami. However, in most cases, backlogs mount gradually […]

Meltdown and Spectre

by Andrew Witchger The Issue While it might sound like the James Bond franchise just released a new movie, Meltdown and Spectre are the names given to two newly discovered methods to exploit critical vulnerabilities found in nearly every processor in circulation today. While major hacks in 2017, such as WannaCry, NotPetya, Bad Rabbit, targeted […]

ERISA External Reviews: Statutory Mandate for Legal Experts in Coverage Determinations

By Jim Bobeck As a law, ERISA is a complicated hodgepodge of many provisions regulating pension, health plans, and patient protections. Tucked away in paragraph (d)(2)(iii)(B)(1) of 45 CFR 147.136 is a seemingly innocuous provision that in summary states the following: Health insurance issuers (not just plans) must have an external appeals process where appeals are […]

Keep Calm and Carry On: Why Artificial Intelligence Is Not Going to Take Your Job

By Andrew Witchger   “Elon Musk’s Billion-Dollar Crusade to Stop the A.I. Apocalypse” “More than 70% of US fears robots taking over our lives, survey finds” “WILL AI TAKE OVER? ARTIFICIAL INTELLIGENCE WILL BEST HUMANS AT EVERYTHING BY 2060, EXPERTS SAY”   Headlines like theses seem to cover the front pages of major news publications […]

Medicaid: Serving All

By Lauren Bremer When it was first created in 1965, Medicaid was intended to insure low income individuals. Since then, it has grown vastly, now covering mental health, substance abuse programs, HIV treatments, children, pregnant women, and seniors—in total more than 75 million Americans. The U.S. government has tried to provide insurance to every American […]

5 Signs That You’re Not Truly Using Agile Methodology

By Andrew Witchger The daily stand ups are longer than 15 minutes. The idea of a daily stand up is for each team member to give a quick update about what they accomplished yesterday, what they hope to accomplish today, and any challenges they are facing in the development process. When the content of the […]

6 Thought Leaders You Should Already be Following on LinkedIn

By Lauren Bremer LinkedIn has become the place for healthcare professionals to network and stay current in thought leadership. To get started, here are six impactful LinkedIn accounts exploring the nexus of healthcare, technology, and government.   Brian Ahier: As the Digital Health Evangelist at Aetna, Ahier has been nationally recognized for his work with […]

Staff Up or Contract Out?: The Government Agency Dilemma

By Jim Bobeck For any state agency facing new work or spikes in existing work volumes, a critical question must be asked: Do we staff up or contract out? An agency’s workload can change in an instant, for reasons ranging from Medicaid expansion to budget freezes. These three essential principles can provide guidance on the […]