Professional Services Network, Inc. has expert consultants who can help you in the following areas.
If you are interested in speaking to us about your needs, we can provide a free one hour consultation to evaluate your goals and to provide you with an estimated fee for service. Please contact [email protected] to discuss how you can connect with one of our consultants.
- Assist with development of a Quality Care Committee, and implementation of industry best practices for QI projects
- Engage with QI Management and key staff regarding potential improvements to the company’s QI program and specific QI projects.
- Strategize on Clinical Quality Oversight
- Mentor staff in developing and improving their knowledge base and competence in quality improvement processes
- Provide guidance in operationalizing programs and projects
- Assist in identifying optimal structure for QI program, including strategies for working with private sector agencies
Interim UM Consulting
- Improve program efficiency
- Assist you in complying with regulatory standards
- Conduct an initial assessment of Prior Authorization, Concurrent Review and Appeals & Grievance processes with facility staff.
- Evaluate current requests for authorizations including present processes and procedures, use of Milliman Care Guidelines, MCOs and third-party payors.
- Review documents, work processes, documentation practices and data management activities with staff.
- Conduct a preliminary patient file review to assess current practice and identify potential
- Documentation Gaps.
- Identify and document comprehensive analysis on issues creating denials for services.
- Educate staff on appeals process, improving appropriate documentation as needed.
- Notice of state legislation or voluntary requirements that enable continued compliance.
Interim CM Consulting
- Implement a complete redesign of case management department to improve efficiency and productivity
- Complete evaluation and financial analysis of functions to streamline roles.
- Complete a full assessment of staffing ratios, staff skillsets and strengths, and educational needs.
- Provide in-service hospital-wide educational opportunities to nursing leadership, case management, and executive leadership to increase competencies; including education on federal reimbursement for Medicare.
- Focus on denial prevention and readmissions reduction.
- Provide guidance on HEDIS measurement, analytics, reporting and submission
- Serve as a Subject Matter Expert for HEDIS®, CAHPS ®, HOS, QRS, QHP-EES, and CMS Medicare Advantage