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
September 16, 2019
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
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
June 21, 2019
The Future of Revenue Cycle Management: Intelligent Process Automation
Healthcare organizations face mounting challenges in their battle to control costs and deliver quality patient care. Revenue Cycle Management (RCM) continues to be one of the most daunting obstacles to realizing efficiencies without compromising care. Fragmented processes, disjointed data sources and increasing regulatory policies all add layer of complexity and costs in an area of healthcare that touches every player including the patient. Intelligent Process Automation (IPA) is emerging as one of the most transformational technologies that can help healthcare providers by automating many of their labor intensive, costly, and error prone tasks. IPA has the potential to free up… Read entire article here
