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Category: Revenue Cycle Management

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May 26, 2022

The Great Resignation and Understaffing Are Here. Can Automating Prior Authorization Help You Cope?

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization, Revenue Cycle Management

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

May 10, 2022

How to Make Coordination of Benefits More Transparent and Truly Coordinated 

by Jen | Healthcare Technology, Revenue Cycle Management

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

May 2, 2022

Why Calculating Patient Financial Responsibility is the Key to Happier Patients and Increased Revenue

by Seth McCulloch | Healthcare Administration, Revenue Cycle Management

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

May 2, 2022

Why Automation is the Key to Fixing Prior Authorization

by Jen | Healthcare Administration, Healthcare Technology, Revenue Cycle Management

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