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
The US finds itself woefully unprepared to perform enough COVID-19 testing to identify and quarantine infected patients at scale, slowed by test development regulations; a disbanded White House pandemic response team; and a lack of coordination between local, state and federal governments. This lack of “systemness” in the healthcare system has left clinical laboratories scrambling to receive testing approval from the Centers for Disease Control (CDC) and ramp up production. Fortunately, testing guidelines were loosened by the Federal Drug Administration (FDA) at the end of February, allowing academic labs and large commercial labs like Quest Diagnostics and LabCorp to quickly… Read entire article here
Last week, we participated in the Diagnostic Coverage and Reimbursement Conference in San Diego. It was an intimate gathering that brought together executives from diagnostics and genomics laboratories, and payers to openly discuss reimbursement, market access, and revenue cycle challenges and what can be done to address them. The two topics that permeated most discussions were prior authorization and price transparency. Prior Authorization There was consensus among all attendees that the increase in prior authorization requests has been problematic and that providers and payers need to work collaboratively to improve adoption, reduce physician abrasion and — most importantly — provide… Read entire article here
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
