Articles Tagged With: authorization
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Automation, Artificial Intelligence Future of Patient Access Authorizations
A revenue cycle operator explains how his department is breaking free from old-fashioned practices and moving toward automation.
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Evidence Shows Prior Auth Requirements Hurt Patient Care
Complying with health insurance companies’ prior authorization requirements is demanding ever-increasing resources from patient access. The authors of multiple recent studies found these requirements also stop patients from receiving needed — and sometimes life-saving — medical care.
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Peer-to-Peers Not Always Successful; Patient Access Can Increase the Odds
Patient access does its part by obtaining authorizations for scheduled cases. Thorough documentation in the medical record gives the payer no reason to ask for the peer-to-peer in the first place.
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Insurance Companies Steering Patients Away From Hospital Sites
Registrars are canceling procedures on short notice much more often these days, not because anyone needs to reschedule but because insurance companies are contacting patients to tell them the hospital setting will cost more.
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Dozens of Medical Groups Call for Prior Authorization Reform
Letter indicates physician practices spend nearly 15 hours per week handling more than 30 prior authorizations.
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Prior Authorizations: ‘Top Issue Within the Revenue Cycle’
A growing number of states have passed prior authorization legislation to combat payer requirements resulting in delayed care, lost revenue, and dissatisfied patients.
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Auth Doesn’t Match Service? Expect Claim Denial
Claims denials often occur as a result of “mismatches” between what was ordered or scheduled, and what actually was done. This article discusses how to ensure payment.
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Is Imaging Test Needed ‘Stat?’ Don’t Risk ‘No Auth’ Denial
Payers increasingly are denying claims for “stat” imaging because of no authorization. This article describes practices that can help avoid problems.
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Payers claim procedures weren’t medically necessary
With medical necessity denials, “prior authorization is ‘job-one,’” says John Holyoak, director of product management at RelayHealth Financial, which is based in Alpharetta, GA.
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There's Got To Be A Better Way
Each month, Baptist Health System handles more than 1,500 requests from physician offices to obtain authorizations for scheduled services.