Prior Authorization: Concept vs Execution To contain costs, health insurers and laboratory benefit managers (LBMs) rely on utilization management to introduce checks and balances that assess the appropriateness of a prescribed care regimen before authorizing it. The thinking behind this being that a less expensive option may be sufficient and that a stepped approach to patient care makes more financial sense than simply defaulting to the most expensive option. To make utilization management work, payers and LBMs increasingly require providers to obtain prior authorization, a preemptive check to gauge the medical necessity and cost ramifications of a prescribed treatment and… Read entire article here
Introduction Lots of industry pundits and armchair experts have weighed in with their analysis of how blockchain technology — and its impact on data integration and exchange, information security, and real-time accessibility of data — will transform care delivery. But while much has been opined about the transformative effects that blockchain will usher in for hospitals and healthcare systems, little has been written about its potential applications for alternative site healthcare organizations like diagnostics labs, infusion providers and specialty pharmacies. This post will address some specific blockchain use cases for these markets. But First Some Context If you are already… Read entire article here
August 22, 2019
How Medical Concept Embeddings Can Help Reduce Billing Errors
by Tyrone DeSilva | Healthcare Technology
One of the problems that Myndshft seeks to solve in healthcare administration is automating and improving medical billing. Currently, medical billing is composed of tedious manual processes, which introduce errors and latency that drive up costs and reduce provider and patient satisfaction. Machine learning and process automation are part of the toolbox Myndshft uses to tackle these challenges. In order for machine learning and process automation systems to be effective, they first need to learn to comprehend claims data. Claims data commonly contains two ontologies, International Classification of Disease, 10th revision, Clinical Modification (ICD-10-CM) and Current Procedural Terminology (CPT). The… Read entire article here
Lack of healthcare transparency. The tensions caused by prior authorizations. The tradeoffs between cost and care. These aren’t abstract concepts to Myndshft’s Director of Talent, Maria Montoya. Here is her story. “You’re too young to be here.” After trite introductions, those were the first words spoken by a silver-haired surgeon explaining the implications of my breast biopsy. Two months after my 30th birthday, flanked by my mother and husband, this man laid out the road ahead: first there would be surgery, likely not chemo, no radiation. It was still early, but nonetheless clear that I had breast cancer. I recall… Read entire article here
