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Insights and analysis on the latest happenings throughout the healthcare system.

Payer Strategies In The Time of COVID-19, part 3

Blogs
This is the third part of a three-part series on strategies for payers during the COVID-19 pandemic.    The situation surrounding COVID-19 is changing day-by-day or even hour-by-hour, and has derailed most of our normal patterns: People are working from home, kids are home from school, restaurants are closed, and the healthcare system has become...
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Payer Strategies In The Time of COVID-19, part 2

Blogs
This is the second part of a three-part series on strategies for payers during the COVID-19 pandemic.    The situation surrounding COVID-19 is changing day-by-day or even hour-by-hour, and has derailed most of our normal patterns: People are working from home, kids are home from school, restaurants are closed, and the healthcare system has become...
Read More

Payer Strategies In The Time of COVID-19, part 1

Blogs
This is the first part of a three-part series on strategies for payers during the COVID-19 pandemic.    The situation surrounding COVID-19 is changing day-by-day or even hour-by-hour, and has derailed most of our normal patterns: People are working from home, kids are home from school, restaurants are closed, and the healthcare system has become...
Read More
We've all been there

We’ve all been there…

Blogs
We’ve all been there…sitting anxiously in our PCP’s office waiting for the result of some routine tests. As the doctor comes back with the results, you hope he or she is going to say, “you’re good to go,” but instead they tell you those five dreadful words: “you should see a specialist.” The doctor likely...
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Scribes for the Win!

Blogs
Medical scribes have become an integral part of the medical landscape.  By 2019, there will be 100,000 medical scribes, roughly 1 for every 9 physicians.   Written By Amika, Client Operations Manager at ReferWell and former Medical Scribe   As our country has moved into the era of EMRs, we are still in the process...
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The Burden of Prior Authorizations

Blogs
Prior Authorizations are one of the myriad of examples of inefficiency, bureaucracy, and red-tape that bogs down our healthcare system.  Unfortunately, prior authorizations are not going away.  This post will explain why prior authorizations exist, the problem with the current prior authorization model, and how we can fix some of the problems. Why Prior Authorizations...
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ELI5: What is a referral?

Blogs
In healthcare, a referral is commonly defined as the act of directing a patient to a medical specialist.  However, that definition is too simplistic.  A better and more comprehensive definition is the act of directing a patient to a medical specialist when: The provider can identify the right specialist to whom to direct (refer) the...
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The Success of the NY State DSRIP Program

Blogs
In April 2014, New York Governor Andrew Cuomo announced that New York would be implementing a series of Medicaid reforms through a Delivery System Reform Incentive Payment (DSRIP) program. The DSRIP program was designed to promote community-level collaborations focused on system reform.  New York is one of nine states to implement the DSRIP program.  To...
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The Implications of the Stark Law As We Shift to Value-Based Care

Blogs
The Stark Law was enacted in 1989 to prevent physician self-referral.  Self-referral is when a physician refers a patient to a hospital, lab or other entity to which he/she has a financial benefit.  The intention of the Stark Law was to eliminate any financial motivation for physicians to refer patients for unnecessary testing or other...
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Referral Management in a Nutshell

Blogs
Q: What is Referral Management? A: Referral Management is the process of a primary care provider (PCP) referring a patient to a specialty care provider (specialist).  There are two routes that a patient could take to see a specialist.  First, the patient books the appointment directly with the specialist.  For example, Joe Camel wakes up...
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Ride Sharing Has Just Entered Healthcare

Blogs
Uber recently launched its newest service line called Uber Health. Uber Health is designed to arrange and facilitate rides for patients that do not have access to reliable transportation. The service does not require patients to have a smartphone, or even a cellphone, and the rides are arranged by a central, cloud-based dispatch portal at...
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Surviving CMS “Crackdowns” on Medicare Advantage Plans

Blogs
A Modern Healthcare article today highlights the importance for MA plans to do a better job of managing their provider networks in terms of maintaining accurate directory information and ensuring availability for Medicare patients they’re covering (see the full article). A properly organized and managed referral management system (like ReferWell’s, for example) provides not only...
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Can We Talk?

Blogs
The last decade has seen the rapid adoption of the electronic medical record (EMR). While a few major EMR software companies have become familiar names, the overall market is very fragmented, with a dizzying array of products available for almost every type of practice, budget and clinical need. But the health care industry has a...
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A Referral Is The Building Block Of Your Health Care Network

Blogs
In today’s environment, health care has become increasingly specialized. Primary care physicians (PCPs), once careful to refer patients out in the “gatekeeper” HMO model, have now left these habits behind and come to see themselves as coordinators of care among the patient’s multiple specialists. Part of this is explained by the advancement and complexity of...
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