“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
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
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
