Articles Tagged With: authorization
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If CPT Code Changes, Patient Access Can Obtain Payment
Patient access can intervene to stop an unauthorized test, assuming it is not emergent or urgent — or find out if the patient wants to go forward anyway. Registrars' expertise makes all the difference on whether the hospital is paid, and how quickly. Possibly, the health plan will agree a new authorization is unnecessary — as long as the clinical records are sent with the claim.
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Revenue Depends on Correct CPT Codes; Beware Sudden Changes
The revenue loss caused by CPT code changes is nothing short of staggering. When it comes to CPT codes that change after service, one of the biggest challenges is in the surgical space. Learn how some patient access departments are proactively addressing this problem.
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Data Are the Key to Avoiding Claims Denials
Claims denials have increased by 11% nationally since the onset of the COVID-19 pandemic, according to an analysis. Almost half of claims denials are caused by front-end revenue cycle issues, including registration/eligibility, authorization, or service not covered. Implementing a process to check eligibility at multiple points throughout the revenue cycle will go a long way in preventing this common denial from occurring.
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Feds Redefine Who Can Handle COVID-19 Vaccine
HHS expands list of who can prescribe, dispense, and administer shots.
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Understanding Emergency Use Authorization Issues with COVID-19 Vaccine
Current COVID-19 vaccines have not undergone the process for full FDA approval, but have been authorized under a streamlined process known as an emergency use authorization. Because of this, the vaccines are technically considered experimental and are subject to regulations that may affect whether employers are permitted to mandate their use by employees.
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Health Plans Turn to Third Parties to Handle Claims and Authorizations
Health plans are increasingly working with third-party business partners to manage certain operational activities. Although third parties may help save money, for patient access, it could mean more claims denials and authorization hassles.
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Automating Auths: Not as Simple as It Sounds
If electronic prior authorization was implemented fully across the industry, the extra hours of work and high costs could be reduced significantly.
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When It Is Life and Death, No Time to Wait for Authorization
Denied claims for urgent, medically necessary procedures are no laughing matter. Patient access staff have to appeal each denial, a time-consuming and expensive process. A New York law states that if a patient presents with unexpected complications or requires additional services in the course of treatment, a health insurer will no longer be able to deny payment due to lack of prior authorization.
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The Pushback to Burdensome Authorization Requirements Has Begun
It is hard to dispute the fact that prior authorization requirements place a heavy burden on both patients and providers. Yet the number of services and medications requiring auths continues to increase. Read on to learn about several trends.
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Patient Care Goes Forward as Planned: ‘You’re Good to Go’
Patients tend to become anxious when scheduled care is cancelled due to authorization holdups. This happened so often in one system that a decision was made to change the process. If the payer takes too long to give an answer one way or the other, things go forward as planned anyway.