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AllMed Articles

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Document A Cut Too Deep
By exporting a peer review case to an independent review organization, a hospital ensures patient safety and best practices.
Document Doctors Pass-Along Prescription Deadly
A hospital misses an opportunity for a doctor's peer review, costing a man his life.
Document Shortcomings of Internal Peer Review
It's no secret that hospital peer review is a broken process. Improving the quality of care for patients by protecting them from substandard medical care is an admirable goal and one that doctors and hospital risk managers agree on.
Document New Standards Increase Conflict of Interest Concern
The likelihood of conflict-of-interest issues are increasing due to the Joint Commission's new and ardent standards for hospital credentialing and physician privileging.
Document Best Practice: Credentialing Low-Volume Providers
If a physician in your hospital group does not meet the clinical activity required for re-credentialing, how do you determine his or her competence before assigning privileges?
Document Improperly Maintained Equipment Caused Overdose
An external peer review finds a hospital at fault for failing to update medical equipment.
Document 5 Tips to Make Your IRO Perform Better
Here are few tips that will help an IRO meet your expectations and provide you with meaningful outcomes for both the patients and your company.
Document TPA and IRO Partnerships Reduce Claims Costs
By partnering with an IRO, TPAs can better manage their case loads and improve their ability to make decisions within required deadlines. Together the two organizations work to allocate medical resources where they are needed, which helps decrease the overall cost of health plans.
Document Fetal Biophysical Profile and Nonstress Testing
Using the biophysical profile (BPP) and nonstress test (NST) to monitor fetal activity allows doctors to determine if uteroplacental function is adequate.
Document Renal Transplantation for HIV and Obese Patients
The field of renal transplantation has been both a victim and a beneficiary of improved survival in patients with chronic medical diseases. Not more than 10 years ago, HIV and significant obesity (a body mass index above 35) were considered absolute contraindications to receiving a kidney transplant. Today these medical issues are part of the changing landscape of renal transplantation.
Document Anorexia Nervosa: Adjustments in Food, Mood and Attitude
An overview of Anorexia Nervosa including information on symptoms, treatments and insurance coverage.
Document Overcoming a Shortage of Non-Conflicted Specialists in Small Hospital
After experiencing inefficient and inadequate peer review, a quality manager turns to AllMed for external revie help.
Document External Peer Review Heads off Litigation
After internal politics and a lawsuit threat prompted conduct external peer review, a hospital hires an independent review organization to sort out and establish the red flags of the case.
Document Conflict Avoidance During Re-Credentialing
This case serves as an example of how re-credentialing specialist practitioners can trigger the need for external peer review in order to avoid conflicts and ensure objectivity. With The Joint Commission’s 2007 standards related to Focused & Ongoing Professional Practice Evaluations, the need for external peer review in conflict of interest situations is critical to performing re-credentialing tasks.
Document Little Evidence Vision Therapy Works for Kids
Vision therapy is an expensive alternative therapeutic specialization that uses eye exercises to improve and maintain good visual function thought to help struggling children learn better. However, doubts, bolstered by the American Academy of Ophthalmology, that vision therapy is an effective treatment have risen.
Document Preteen and Teen Depression Treatment
With childhood and adolescent depression becoming more prominent in today's society, establishing a concrete treatment plan is more important than ever. An effective treatment plan includes a combination of psychotherapy and antidepressants.
Document Lyme Disease
Details the three stages of Lyme Disease and the optimum diagnoses and treatment plan for each stage.
Document 9 Hints / Telltale Signs that Say You Need an IRO
Using an IRO is an efficient and defensible way to manage a health plan properly for both the insurer and the patient. As unbiased advocates for managing healthcare costs, IROs ensure that every claimant is properly served, every time. Read more for nine hints and telltale signs that you need an IRO.
Document Photodynamic Therapy for Skin Cancer
With skin cancer's prominent death toll, using the best treatment practices is vital. Both nonmelanoma and melanoma cancers resopnse to photodynamic therapy, an FDA-approved treatment for skin cancer that combines a light source and a photosensitizing agent to destroy cancer cells.
Document Botulinum Toxin for Migraines
Using botulinum toxin injections is a controversial treatment to prevent migraine headaches. Some studies suggest that patients experience fewer migraines while other studies fail to support the claim.
Document Should Case Managers Approve VNS (Vagal Nerve Stimulation) Therapy For Major Depression?
A fourth therapeutic treatment for major depressive orders, called vagal nerve stimulation, is a new proposed procedure for treating resistant depression by implanting a therapy pulse generator and lead and using external programming to change stimulation settings.
Document Bariatric Surgery: Cosmetic or Necessary?
The rise of obesity is leading to a rise in the demand of bariatric surgeries. With this rising demand comes questions of medical necessity. The article provides a summary of reviews that hinge on what is considered medically necessary or optional in terms of bariatric surgery.
Document Cancer Treatment
This widespread availability of cancer experimentation and treatment options causes confusion not only among the lay community, but among physicians and payers as well. Having access to Board-Certified Oncologists and Hematologists as part of the independent review process can help payers ensure patients receive the best medical care possible as approved by their contracts.
Document Cancer Trials - Are They Ready for Prime Time?
Clinical trials not only help identify better and safer anti-cancer drugs, but often lead to new standards of care and improved quality of life for those battling cancer. Read more to understand the clinical trial process.
Document Chiropractic Medical Necessity: The Reviewer Perspective
Because it is an alternative practice of medicine, chiropractic treatment requires documentation to substantiate its medical necessity by most third party insurance payers. Documentation nearly always includes a patient's past and present history, consultation form, chart notes and any required imaging.
Document Da Vinci Robot: Best Choice For Prostate Surgery?
Underlines the pros and cons of the robotic approach to prostate surgery.
Document Deciding the Medical Necessity of Insulin Pumps
Understanding the basics of the insulin pump will aid payors determine which patients are the best candidates for insulin pump treatment.
Document Defining Peer Review
Learn to differentiate between peer review, independent peer review and credentialing peer review.
Document Diagnosing Adult Growth Hormone Deficiency
Although diagnosing adult growth hormone (GHRh) deficiency is difficult and can lead to additional health complications, it is not an impossible process. Tests include the "gold standard" and GRHg stimulation techniques. Like diagnosing, treatment of GHRh deficiency is expensive and has significant side effects.
Document Shockwave Therapy For Plantar Fasciitis
Although treatments like orthotics, splinting, ultra sound, weight loss and cortisone injections exist for plantar fasciitis, the newest treatment being touted on the market is shockwave therapy. An expensive and controversial treatment, shockwave therapy is a treatment that external review specialists must determine its medical necessity.
Document Getting The Most From Your Independent Review Organization
When requesting an independent medical review, careful consideration needs to be given to focusing on the specific issue(s) you’re trying to resolve. Understanding what questions to ask in the first place will help keep costs at a minimum by ensuring your IRO is reviewing the proper records and facts and correctly delivering decisions on the issues at hand – the first time.
Document Hospital Peer Review Survey Results
After conducting a peer review survey, AllMed finds that hospitals and medical groups are proactive in their peer review through utilization of an independent review organization.
Document Hospital Stays - When to Pay for the Last Day
Payers should understand that eliminating coverage of a patient's last day of a hospital stay will not necessarily result in cost reductions.
Document How New Technology Can Help Claims Managers
New advancements in information technology (IT) are helping claims managers better respond to patients' needs, meet mandated guidelines, ensure patient privacy and bring efficiencies to the overall process.
Document Improving Internal Medical Peer Review
With internal medical peer reviews becoming a practice of the past, hospitals and medical organizations are outsourcing reviews to independent review organizations to curb costs and uphold standards of care and avoid conflicts of interest.
Document IROs and the Hospital Peer Review Process
Using an independent review organization as part of the peer review process is not focused on finding and punishing "bad" doctors. Rather, an IRO takes a systematic approach to determine the reasons for sentinel events and a broader range of queries.
Document Laser Eye Surgery – Will Insurance Pay? Determining the Medical Necessity of “Cosmetic” Treatments
The practice of not covering high-cost laser eye surgeries is shifting as refractive eye surgery is being determined medically necessary more often.
Document Make Your Next Review Easier (and possibly save money)
If you´re a claims manager, case manager or utilization management nurse and are sending cases to an IRO for independent review, here are four important tips that can make your next review easier—and maybe less costly.
Document Making ERISA and DOL Appeals Easier and More Cost-Effective
Simply stated, under DOL and ERISA, when a benefit plan denies a claim, the claimant has the right to appeal a decision and the review of the appeal must be made by someone who’s at “arms length,” is a like specialist and who was not involved in the initial review process. Turning to an independent review organization for this review assures compliance and eliminates risks for payers.
Document Managing Evidence-Based Self-Insurance Plans
How do the management companies, without a full medical panel on staff, decide that treatment decisions are based on proven medical evidence each and every time? How do these companies ensure that they are staying up-to-date with the latest medically approved treatment options? The answer: An Independent Review Organization.
Document Move Toward Best Practices for Hospital Peer Review
An independent review organization can quickly help hospital litigation teams and quality managers understand litigation cases and provide outside insight into a peer review case.
Document Obesity Letter
Until recently, not all insurance plans have covered gastric bypass surgeries. However, as obesity reaches an increasing level of crisis in the country, this practice is changing.
Document Outsource Hospital Peer Review to an Independent Review Organization
In order to conduct efficient peer reviews and avoid conflicts of interests, outsourcing hospital peer review is the best practice for hospitals. Using a third party, hospitals receive an objective, non-conflicted decision and fast turn around time.
Document Outsourcing Preauthorizations For Improved Outcomes
Increasingly, medical management firms and managed care organizations are turning to Independent Review Organizations (IROs) to pre-authorize treatments at the forefront of the healthcare decision-making process. Read to find out why.
Document Removing Conflicts of Interest in Hospital Peer Reviews
In terms of satisfactory outcomes, it´s widely known that medical peer review inside hospitals and medical groups is at best complex and at worst conflictive. Outsourcing to a third-party IRO immediately removes any conflict of interest for a hospital and speeds up case resolution. A good reputable independent review organization can offer a panel of specialists in all specialty and sub-specialty areas, as well as a group of actively practicing, board-certified and licensed doctors.
Document Removing Varicose Veins for Healthy Legs – Is It Covered?
There a multitude of causes that contribute to a patient's inclination to develop varicose veins. Covering the removal of varicose veins for healthy legs requires specific requirements throughout a patient's screening, diagnoses and treatment process.
Document Streamlining Sleep Apnea Diagnoses
Rather than performing multiple, separate diagnostic and therapeutic tests for sleep apnea, doctors are now combining the two into a single study.
Document Ten Reasons To Use An Independent Review Organization (IRO)
Increasingly, healthcare providers, insurers, medical directors and case managers are turning to Independent Review Organizations (IROs) to collaborate on the decision-making process for medical claims. At question, however, is when in the decision-making process does this make the most sense? Here are the top 10 signs to identify when to bring in an IRO:
Document Understanding FDA Approval for Medical Devices: Vest Airway Clearance System
While FDA approval for a drug product suggests safety and efficacy, the same approval for medical devices does not. Approval for a device only assumes the manufacturing method is reliable and that the device is similar to another on the market. One such device is the Vest Airway Clearance System.
Document What to Consider for Sleep Apnea Treatment
Because sleep apnea can be caused by a handful of different factors, treatment options vary. Understanding the cause of the sleep apnea is the first step towards deciding the best treatment option for the patient.
Document When Is Eyelid Surgery Medically Necessary?
 
AllMedArticle Off-Label Avastin Use For Wet Macular Degeneration
Researchers have determined that off-label use of Avastin is an effective treatment for wet AMD, the leading cause of blindness in people over 50 years old. Although physicians and researchers are debating the effectiveness of Avantis versus Luncentis, a drug that costs 40 times more than Avastin, some ophthalmologists consider the two to be equal.
AllMedArticle Case Study: Chief of Surgery Shifts Risky Cases
By exporting a peer review case enveloped by conflicts of interest, a hospital reveals a chief surgeon's unfair practices.
AllMedArticle AllMed Announces Contract with HealthTrust Purchasing Group
AllMed Healthcare Management, Inc. today announced a major contract with HealthTrust Purchasing Group, LP.
AllMedArticle Understanding Focused and Ongoing Professional Practice Evaluations
Learn what the Joint Commission's new standards on the peer-review process mean for hospitals and physicians, as well as the difference between focused professional practice evaluation and ongoing professional practice evaluation.
AllMedImage Articles Masthead
 
AllMedArticle Avastin (Bevacizumab) Therapy in Oncology
 
AllMedArticle When Renal Artery Stenosis Screening is Medically Necessary
 
AllMedArticle Diagnosing and Treating Circadian Sleep Disorders
 
AllMedArticle Developmental Delay: How to Diagnose, Plan Exclusions
Developmental delay is a term applied to a wide range of disorders, including mental retardation, motor delays, developmental language delays, developmental coordination disorders, autism spectrum disorders and global developmental delay. Before modern imaging and genetic studies, the term described any child not achieving developmental milestones and in whom a medical diagnosis had not been identified.
AllMedArticle Battling Childhood Obesity with Bariatric Surgery
With childhood obesity becoming an ever-present epidemic, the issue of patient qualification for bariatric surgery needs to be revisited. Recent data shows that nearly 17 percent of US youth between the ages of six and 19 are considered overweight.
AllMedArticle Management and Care of Acute Coronary Syndromes
Atherothrombosis is the leading cause of death worldwide and accounts for 52 percent of all deaths. Over 55 million people worldwide died from atherothrombotic disease in 2000. In 2004, there were 1.6 million of hospitalizations for ACS, 700,000 for UA and 900,000 for myocardial infarction (MI). Of these, about 30 percent presented ST-segment elevation in the electrocardiogram (ECG).
AllMedArticle AllMed Introduces New CardioAudit Service
First-of-its-kind program designed to help hospitals ensure their cardiology procedures and surgeries are in full compliance with latest Medicare and Medicaid requirements
AllMedArticle Off-Label Use of Biological Agents in Rheumatological Diseases
 
AllMedArticle First-Trimester Aneuploidy Screening
 
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