June 29, 2022
Health Tech Regulation: 3 Heads-Up Ways to Keep Pace
by Susan Lawson-Dawson | Healthcare Technology
“Are we there yet?” It’s a familiar refrain for families taking a summer roadtrip. But the meandering road to healthcare interoperability leaves providers, payers, and patients questioning how long this journey will take. Evolving health tech regulations and standards could fuel progress on interoperability, prior authorization automation and more. What do you need to do to stay on the right track? 1. Improve price transparency The price transparency final rule went into effect in January 2021, but until recently, the CMS has relied on warning letters rather than stronger enforcement tactics. That changed this month with the recent fines levied… Read entire article here
The numbers tell the story. Preliminary data from the U.S. Bureau of Labor Statistics saw March job openings outpace new hires by more than 1.3 million. Perhaps even more concerning: 682,000 people left healthcare during the same period. A recent advisory from U.S. Surgeon General Vivek Murthy warns that burnout is a root cause of this ongoing exodus. Acknowledging that the pandemic amplified problems already contributing to burnout, Murthy notes, "... the response to burnout and health worker well-being must be multi-pronged. For example, a health worker may find it difficult to spend sufficient time with patients due to their… Read entire article here
The Concept The concept behind coordination of benefits (COB) is fairly straightforward and simple. In situations where a patient has multiple health plans, it’s a way for commercial and government insurers to determine which payer is responsible for coverage, in what amount, and in what order — as a primary, secondary or tertiary payer. For instance, two spouses may pay for health insurance under each of their employer’s plans, so each would be covered under their plan and their spouse's plan. Or a single person may have Medicare and additional health care coverage under a supplemental plan. Coordination of benefits… 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
