AHC Blog

Utilization Management: How to Reduce Costs without Denying Care? - By Dr. Singh

June 13, 2017

Utilization management (UM), care management, control of spiraling costs, care coordination: these are all the words we hear regularly these days with the advent of accountable care and increased enrollment in managed care plans across the country.

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SMART Office - By Dr. Singh

June 12, 2017

We hear about smart cars and smart phones, smart cities and smart manufacturing plants a lot these days. Greater use of technology is expected to alleviate many of the problems faced by these entities and create some solutions. Can a smart office exist in a similar vein?

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Peace and wellness to all - By Dr. Maria Scunziano-Singh

June 12, 2017

Our goals are honorable and we would like to see them all happen. This "community" has done a very fine job of helping many in communities here and far despite all that we must face in these uncertain times.

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SMART Data - By Dr. Singh

June 06, 2017

We have heard about SMART goals. It seems to me in this world of big data, analytics, cognitive computing and artificial intelligence that we need SMART data as well. George Doran and Robert Rubin have reviewed the acronym and what it could suggest to us, making it easier for us to understand what shared goal-making should be.

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A Mathematical Model for Claims Adjudication - By Dr. Singh

June 01, 2017

Medical Claims Adjudication is an arduous process. Creating a platform to facilitate it via automation, or even manually, is even more arduous. There are innumerable kinds of claims, more than 11, 000 possible edits, approximately 80,000 ICD 10 codes

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An Approach to Care Management - By Dr. Singh

May 12, 2017

Your patient comes in for his scheduled visit. The exam is unremarkable and he reports he’s doing quite well. Then, right before he leaves, he insists that you give him an approval for an electric scooter so that he can shop more easily in Walmart.

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Coding and Billing: Time to go Deeper - By Dr. Carlos Arias

May 09, 2017

It is now time for physician practices to get revenue cycles in order to improve financial performance. The healthcare revenue process involves scheduling, registration, case management, clinical charge processing, medical records, billing, payment posting, and revenue recovery.

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Pre-billing: A Safety Net - By Dr. Carlos Arias

May 06, 2017

Imagine driving on a narrow road between two mountains. Suddenly, rocks begin tumbling down around you from both sides. That is, I believe, the feeling many providers and healthcare companies get when a final decision from a federal or civil court gets published on the Office of Inspector General (OIG) website.

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The First Impression: Waiting Rooms and Reception Areas - By Dr. Carlos Arias

May 03, 2017

The introduction to a medical practice begins in the waiting and reception area. A patient’s perception of the practice starts there, and it’s an impression that will be perceived as who we are. We should use every action and opportunity available in this location to promote the practice.

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Risk Adjustment: A Compliant, Efficient and Medicine-Based Approach - By Dr. Carlos Arias

April 29, 2017

As premiums continue to be reduced, Health Plans, IPAs, MSOs and medical groups must have plans in place that ensure an accurate RAF score. To obtain these, healthcare organizations must not only recapture the enrollee’s prevalent conditions, but compliantly report clinical conditions as they appear.

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How Do Organizations in Healthcare Measure the Value Proposition? - By Dr. Carlos Arias

April 26, 2017

How Do Organizations Measure the Value Proposition? Both the numerator (Quality) and denominator (Cost) must be measured to demonstrate value. We achieve Quality through Effectiveness, Patient-Centered Care, Safety, Efficiency, Equitability and Compliance.

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Smart Defense in the Legal Era of Whistleblowers - By Dr. Carlos Arias

April 24, 2017

Where will a whistleblower act next? Is my company at risk? These are questions that are asked by executives, lawmakers and compliance officers the world over, every day.

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