Prior authorizations play a crucial role in the revenue cycle. The process greatly impacts reimbursement and patient access to care, and consequently, the financial performance of healthcare organizations. To simplify the process and reduce denials, a growing number of healthcare providers have pinned their hopes on prior authorization automation. The benefits of adopting prior authorization automation Prior authorization automation shows promising results across the healthcare industry. Reporting on a recent survey, HealthLeaders notes that 78% of respondents saw improved financial performance following implementation of automated prior authorization. What contributes to better bottom lines? Automation eliminates repetitive data entry, improving staff… Read entire article here
Recently Ochsner Health cut 2% of its workforce, pointing a finger at reimbursement rates that have failed to keep pace with inflation. Ochsner isn’t alone. Many healthcare providers face a similar dilemma, especially now that the Public Health Emergency (PHE) has ended. As a result, many healthcare providers have targeted mostly management and non-clinical roles in their layoffs. Unfortunately, that means fewer staff to manage the ever-growing burden of prior authorization. That’s where end-to-end prior auth software can help. Why downsize when you can upgrade? With the increasing pressure to streamline operations and reduce costs, healthcare providers confront the difficult… 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
