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
Revenue cycle departments at diagnostics labs face some really daunting challenges when it comes to managing patient co-pays 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 second in a series of five blog posts that will reveal the findings from these interviews. To read the first installment, click here. You can also download the full report. Claim Denials For diagnostics… Read entire article here
February 3, 2022
The RCM Pitfalls of Limited Visibility to Patients Prior to Service
by Developer | 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 first in a series of five blog posts that will reveal the findings from these interviews. You can also download the full report. Limited Visibility to Patients Prior to Service When you conjure up… Read entire article here
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
