Tag: Prior Authorization

Automating Claim Processing

Automating Claims Processing in the Healthcare Industry

By utilizing automation, it is feasible to improve the upstream and downstream adjudication process through data validation and routing. The healthcare industry can benefit from automation in almost all administrative functions, but it can significantly improve the auto-adjudication rate. In an ever-changing industry, possessing technical expertise is of utmost importance. The healthcare sector is increasingly […]
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Key to RCM Success

Key to RCM Success: Expertise in Denial Management, Coding & Prior Authorization

A survey conducted by leading healthcare technology company, revealed the top revenue cycle tasks like denials management, coding, and prior authorizations requiring the most subject matter expertise. Out of 15 tasks listed, over 550 healthcares financial and revenue cycle leaders identified denials management, coding, and prior authorizations as the top choices. Denials management was chosen […]
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Medicare Advantage Insurers

Senators seek accountability from Medicare Advantage insurers on claims denials

In Congress this week, it wasn’t just pharmacy benefit managers facing scrutiny. The Senate’s Permanent Subcommittee on Investigations directed its attention towards Medicare Advantage (MA) plans, seeking explanations for claims denials. During the hearing, the committee’s chairman highlighted that letters were sent to the three largest MA plans—UnitedHealthcare, Humana, and Aetna—requesting documentation regarding their decision-making […]
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Exploring Capabilities of ChatGPT in Radiology

When Radiology Meets AI: What ChatGPT Can Learn and Contribute

ChatGPT, the large language Artificial Intelligence (AI) model, trained on 570 GB of internet data as well through reinforcement learning from human feedback, is finding a footing in healthcare. It’s already passed a US Medical Licensing Examination, co-wrote a peer-reviewed medical article, and has even written a letter to United Healthcare requesting prior authorization for an echocardiogram. Despite these achievements, […]
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Three-Ways-to-Outsmart-Denials-in-2023

Three Ways to Outsmart Denials in 2023

Denial rates serve as a barometer for the financial well-being of healthcare organizations. An increase in denials can have wide-ranging negative implications for an organization — impacting everything from accounts receivable to the patient experience. By preventing denials upfront, providers can realize revenue faster, boost staff efficiency and satisfaction, and reduce patient anxiety related to […]
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Can-automation-solve-the-prior-authorization-problem

Can Automation Solve The Prior Authorization Problem?

In the latest American Medical Association (AMA) survey, 93% of physicians said prior authorizations delay patient care, and 82% said the process is so complicated that it causes patients to abandon treatment altogether. Prior authorization (PA) remains the top regulatory burden for most health care and medical professionals, often delaying or preventing access to essential […]
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CMS-Aims-To-Streamline-Prior-Authorization

CMS Aims To Streamline Prior Authorization To Reform MA

The American Hospital Association (AHA) and Better Medicare Alliance (BMA) both support the agency’s effort to improve Medicare Advantage (MA). In an attempt to reform MA, CMS released a proposed rule that aims to streamline prior authorization, promote health equity, and curb deceptive marketing. The Biden administration has shown a commitment to increasing oversight of […]
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Prior Authorization Reform in Medicare Advantage | Case Studies | AllZone Management Services Inc.

Prior Authorization Reform in Medicare Advantage

Prior Authorization reform in Medicare Advantage would help relieve administrative burden for medical groups and reduce patient care delays, MGMA said. The Medical Group Management Association (MGMA) has urged CMS to implement policies that support prior authorization reform and value-based care contracts within the Medicare Advantage program. MGMA submitted comments to CMS Administrator in response […]
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Prior-authorizations-and-MedPAC-recommendations

Prior Authorizations and MedPAC Recommendations: MGMA’s view

Prior authorizations and Medicare reimbursements are some of the most consistently cited sources of issues at primary care practices. Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), joined us in April to discuss his organization’s lobbying efforts. The following interview has been edited for length and clarity. Medical […]
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