Tag: prior authorizations
Healthcare is a challenging profession. Providers understand that their mission of care delivery is fueled by the revenues they capture; after all, it is...
For many Americans, access to healthcare is increasingly a question of affordability. There’s no room for error when it comes to determining a patient’s...
What’s weighing on providers’ minds as we head into 2024? According to a 2023 Medical Group Management Association (MGMA) survey, an overwhelming percentage of...
Prior authorizations ensure that patients only receive care that is medically necessary, evidence-based and cost-effective. The process is a built-in safety net to prevent...
The phrase “it’s complicated” resonates well in the realm of prior authorizations in healthcare. Initially devised as a cost control strategy by insurance payers,...
Prior authorizations allow health insurers to determine if a patient’s planned care is medically necessary and how much of the cost they’ll cover. But...
In 2009, processing claims was listed as the second greatest contributor to “wasted” healthcare dollars in the US, at an estimated $210 billion. A...
Full implementation of the Appropriate Use Criteria program has been indefinitely delayed, giving providers more time to prepare. The Centers for Medicare and Medicaid...
Automated claims processing could solve one of the biggest challenges currently facing healthcare providers: maximizing reimbursements by minimizing denied claims. Denials have been steadily...