Moving from fee-for-service to a value-based care model requires a significant change in perspective. What’s one of the most critical changes that needs to take place? Efficient, seamless exchange of patient, provider, and payer data. Unfortunately, healthcare relies on complex data ecosystems and struggles with data silos—a hurdle that hampers the full realization of the value-based care approach. Prior auth software makes short work of data silos, in the process creating momentum for transitioning to value-based care. Prior auth software enables interoperability Data silos occur when data is stored in separate systems, making it difficult to share information across different… Read entire article here
In the last decade, the revenue healthcare providers collect directly from patients climbed from 10% to 30%. Now that patients have more skin in the game, so to speak, their expectations have changed. They want price transparency, convenience, and personalized experiences. To top it off, they’re willing to shop around for a different provider or insurance plan if you fall short on those expectations. Who do they blame when a cumbersome prior authorization process leads to care delays or preventable denials? You. How do you provide a more streamlined, less frustrating patient/member experience? With prior authorization software. Healthcare consumerism has… Read entire article here
Back in February 2018, the American Medical Association (AMA) released a Consensus Statement on Improving the Prior Authorization Process in collaboration with the American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, the Blue Cross Blue Shield Association, and the Medical Group Management Association. The group collectively acknowledged, “The prior authorization process can be burdensome for all involved—health care providers, health plans, and patients.” Yet five years later, prior authorization volume has exploded. Prior authorization automation can relieve the pressures providers and payers face, while accelerating the process so patients get the care they need, when they need it. … Read entire article here
May 2, 2023
The Future of Prior Authorization in Medicare Advantage Plans: New (and Pending) CMS Rules Promise Progress on Prior Authorization Automation
by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization
A decade ago, just over a quarter of eligible Medicare beneficiaries enrolled in Medicare Advantage (MA) plans. As of this year, reports the Centers for Medicare & Medicaid Services (CMS), more than half of enrollees chose MA plans over traditional Medicare. Despite the obvious popularity of MA plans, a problem lurks: overuse of prior authorizations. Because of this, the CMS has begun introducing rules to address the issue, including standards to enable prior authorization automation. MA delays and denials fail to follow Medicare standards A year ago, the Department of Health and Human Services (HHS) Office of Inspector General (OIG)… Read entire article here
