The Recovery Audit Contractor (RAC) is approaching. Where should your hospital's leadership focus its time and attention? The answer is medical necessity, because it's clearly a key RAC target.

Clinical and administrative staff at many organizations are struggling with the issue of what "medically necessary" really means - even those who have reviewed the Medicare Benefit Policy Manual (MBPM ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

I know several colleagues who, like me, trained to be doctors but they later pivoted to take on largely administrative roles working for health plans. Many have a central role in adjudicating what the ...