More payers asking for peer-to-peers
Payers are requiring detailed clinical documentation for authorizations, but providers’ offices often don’t provide the information in a timely manner to patient access. About one-third of claims require clinical documentation at Conway Medical Center, where denials total $2 million to $3 million monthly. To avoid losing revenue, do the following:
- Compare CPT codes that were done with authorizations that were obtained.
- Get clinical information together before calling for authorizations.
- If A Different Procedure Was Done, Send Or Notes To Explain Why.
Patient access needs excellent processes to respond to payer requirements for peer-to-peer review of the patient’s medical records, says Ketan Patel, a senior manager in the healthcare provider segment of strategy and operations for New York City-based Deloitte Consulting
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