October 11, 2022
Why Keeping Up With Prior Auth Requirements is So Hard (And How Prior Authorization Software Helps)
by Susan Lawson-Dawson | Prior Authorization
Have you ever googled ‘prior authorization changes 2022’? (Go ahead, try it.) On any given day, the results are astonishing—anywhere from 76 million to over 100 million in half a second. Is it any wonder that the pursuit of prior authorization remains frustratingly slow? Especially if, like many providers, you rely on a manual process rather than prior authorization software. Before diving into how prior authorization software solves the problem, let’s look at why requirements determinations pose such a challenge. There are two big reasons. State rules for prior auth requirements vary widely Some states have introduced or passed legislation… Read entire article here
“The definition of insanity is doing the same thing over and over again and expecting different results.” It may be one of the most famous quotes that Albert Einstein never said (surprised?), but it came to mind recently. The reason?: A tip in Medical Economics for limiting the impact of prior authorizations on primary care, physical therapy, and other provider practices. Here’s the tip in its entirety: “Assign a staff member to each payer. This person can become an expert on the payers for which they are responsible, learning their specific expectations and what to avoid. They can also build… Read entire article here
“A swelling tsunami of information.” That’s how the Journal of AHIMA described the ongoing surge of legislation and guidance for interoperability. Improving data exchange addresses administrative burdens like prior authorization. During a recent panel discussion with post-acute care providers, we asked for their take on current and proposed laws. What’s promising? What’s not? Let’s start with an approach that’s viewed as a mixed bag. Gold Carding to Reduce Prior Authorization Burden Gold carding refers to the practice of exempting providers from seeking prior authorization of a service IF they have an acceptable approval rating over a specific time period. The… Read entire article here
“Good communication is the bridge between confusion and clarity.” This quote may have originated in the 1800s, but it seems particularly relevant to some of the benefits verification and prior authorization challenges healthcare providers face, particularly in post-acute care settings from home health and physical therapy facilities to radiology and diagnostic labs. Those prior authorization challenges were a recent topic here, inspired by a panel discussion we hosted. Now, let’s dive into what helps bridge communication gaps: interoperability. Why interoperability matters Interoperability is a common goal (and challenge) across healthcare, and post-acute care is no exception. It’s been slow going:… Read entire article here
