Do you rely on referrals for the healthcare services that you provide? Post-acute providers from home infusion to physical therapy typically depend on physician referrals for a significant percent of business. That’s not to say that referrals are always required. In physical therapy, for example, 32 states allow direct access within limits, but only 18 states allow unrestricted access. And we haven’t even touched on payer prior authorization requirements. You're constantly jumping through referral and authorization hoops. The bottlenecks exhaust staff, frustrate patients and damage your bottom line. Not to mention, it creates real barriers to the care your patients… Read entire article here
October 24, 2022
Rev Cycle 911: What is Prior Authorization Triage and Why is it an Antidote for Preventable Denials?
by Susan Lawson-Dawson | Prior Authorization
If you grew up in the 1970’s, your first introduction to “triage” probably came from MASH, the popular TV series about life at a Mobile Army Surgical Unit during the Korean War. Triage was part of nearly every episode, as nurses and doctors quickly assessed and prioritized care for the wounded. Recently, we spoke with a revenue cycle leader who shared a different use for triage: reducing prior authorization denials and the associated financial losses caused by postponed or unreimbursed care. It’s a useful and effective strategy if you haven’t yet automated your process with prior authorization software. Let’s take… Read entire article here
October 17, 2022
Transitioning to Value-Based Care? Prior Authorization Software Can Help
by Susan Lawson-Dawson | Prior Authorization
A push toward value-based care models emerged in 2010 with the passage of the Affordable Care Act. In truth, patient-centered medical homes (PCMH) came about first in 1967. They also saw a resurgence in 1997. But despite decades of value-based care initiatives, the needle hasn’t moved all that far. A 2022 study found that only 15% of providers earn more than half of their revenue from value-based care contracts. Meanwhile, 63% report that less than one quarter of their revenue results from value-based care. Below are some ways to accelerate the transition from fee-for-service to value-based care, from patient engagement… Read entire article here
October 11, 2022
Why Keeping Up With Prior Auth Requirements is So Hard (And How Prior Authorization Software Helps)
by Susan Lawson-Dawson | Prior Authorization
Have you ever googled ‘prior authorization changes 2022’? (Go ahead, try it.) On any given day, the results are astonishing—anywhere from 76 million to over 100 million in half a second. Is it any wonder that the pursuit of prior authorization remains frustratingly slow? Especially if, like many providers, you rely on a manual process rather than prior authorization software. Before diving into how prior authorization software solves the problem, let’s look at why requirements determinations pose such a challenge. There are two big reasons. State rules for prior auth requirements vary widely Some states have introduced or passed legislation… Read entire article here
