Long before patients sit down face-to-face with a clinician—in person or virtually—they have already begun to form opinions about their experiences. Is the patient experience you’re delivering good or bad? Patients attitudes could depend on whether they know how much the service you’re providing will cost. The price transparency mandate that has been in force for providers since January 2021 doesn’t quite get them there. The rule set by the Centers for Medicare and Medicaid Services for “clear, accessible pricing information online” is a start, but to date, compliance has been lagging. In addition, such published lists don’t account for… Read entire article here
May 2, 2022
Why Calculating Patient Financial Responsibility is the Key to Happier Patients and Increased Revenue
Healthcare is like any other service industry: provide the service, get paid. But unlike other service industries, a consumer (the patient) typically does not incur the cost of the service until weeks, months, or even years after it is rendered. Due to variations of inputs within a given visit or procedure and variables around payer contracted rates, the seller of the service (the doctor or provider) may not even know the cost of the service when it is rendered. Herein lies the problem. If a patient is unaware of how much is owed at the time he or she is… Read entire article here
May 2, 2022
Why Automation is the Key to Fixing Prior Authorization
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
Prior authorizations were created, in theory, to reduce the amount of unnecessary or redundant medical treatments, and therefore cut costs and improve patient safety. But in practice, the benefits of prior authorizations have only served to increase the cost for providers. Mention prior authorizations in a room full of physicians and you’re likely to see a fairly animated reaction. According to the Journal of the American Board of Family Medicine, prior authorizations cost the healthcare industry between $23 and $31 Billion each year and the American Medical Association found that the only other measure that physicians rated lower was patient cost… Read entire article here
