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Category: Revenue Cycle Management

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September 23, 2019

Claims Denial Prevention in an Age of Prior Authorization

by Patrick | Healthcare Administration, Revenue Cycle Management

  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

by Patrick | 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

September 9, 2019

How Blockchain Will Fatten the Top Line of Labs and Pharmacies

by Beau Benson | Healthcare Technology, Revenue Cycle Management

Introduction Lots of industry pundits and armchair experts have weighed in with their analysis of how blockchain technology — and its impact on data integration and exchange, information security, and real-time accessibility of data — will transform care delivery. But while much has been opined about the transformative effects that blockchain will usher in for hospitals and healthcare systems, little has been written about its potential applications for alternative site healthcare organizations like diagnostics labs, infusion providers and specialty pharmacies. This post will address some specific blockchain use cases for these markets. But First Some Context If you are already… Read entire article here

August 5, 2019

RCM Technology & Personnel Challenges at Diagnostics Labs

by Patrick | Revenue Cycle Management

Revenue cycle departments at diagnostics labs face some really daunting challenges when it comes to managing patient copays and billing.  We wanted to get a better understanding for the pain points that they face on a day-to-day basis, so we commissioned a market research firm to conduct a series of interviews with revenue cycle executives from across a spectrum of lab services types. This is the final installment in a series of five blog posts that reveals the findings from these interviews. To start reading from the first installment in the series, click here. You can also download the full… Read entire article here