As we look back at 2019, the seeds of active and emerging healthcare industry trends begin to come into sharper focus for 2020. Many of the articles forecasting 2020 trends for the healthcare market read more like predictions from fortune-tellers — so vague and obvious that they cannot possibly be incorrect, but also so vague and obvious that they provide the reader no value. We'd like to take a different approach. What we attempt to do here is dive beneath the superficial talking points and instead, provide our take on less discussed trends that we are observing directly from the trenches. Providing a more… Read entire article here
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
The prior authorization process is a textbook example of the law of unintended consequences. Created for sound reasons — as a utilization management tool for healthcare insurance companies to control costs and protect patients from surprise bills — it has unintentionally paved the way for a corresponding surge in administrative burdens, claim denials and rework. All of which have taken a toll on the revenues of healthcare providers. Not to mention the psyche of revenue cycle teams and patients. The obvious answer to reducing claim denials and ensuing denial write-offs is to prevent them from occurring in the first… Read entire article here
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
