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 Marlene Buczynski at [email protected] to discuss how you can connect with one of our consultants.

 

QIP Preparation 

  • 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.


HEDIS Consulting

  • 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