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Authorization denials are a major issue, one that’s been burdening providers for years. What are the best strategies for succumbing to this malaise?
This month’s E-News Exclusive explores several ideas for making sure everyone, from providers and payers to patients, obtains an ideal outcome.
— Lee DeOrio, editor |
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Prior Authorization Denials: Meeting Today’s Challenges While Building for the Future
By Connie Smith
The cost and administrative burden associated with prior authorizations is not new, nor is it getting better for physicians or health systems. According to MGMA, provider practices report a significant spike in prior authorization requirements since 2020. Some plans are now applying prior authorization to a wider range of services, including those for which the treatment protocol has remained the same for decades and there is no evidence of abuse. And it’s not only the sharp rise in prior authorization demands, as practices also report increased denials, delayed approvals for care, and constantly changing rules.
One critical factor that further complicates the environment is that prior authorizations are still mostly manual, costing an average of $13.40 and 20 to 60 minutes per manual transaction, often completed using websites, phone, and fax. The negative impact on patients and their physicians cannot be underestimated. According to 94% of providers, the prior authorization process causes delays in patients’ access to necessary care, and 30% say such delays have caused a severe adverse event for a patient in their care. For some payers, once an authorization is denied, the provider’s only options are to appeal or wait 45 days to resubmit the request, further slowing the care process.
In this challenging environment, the best approach to preventing prior authorization and claim denials is to focus on the front end of the revenue cycle, ensuring all the information needed to secure the authorization is gathered up front. This article highlights best practices for using revenue cycle and patient access technology to prevent authorization denials today while building a foundation for transforming the process in the future.
Full story » |
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University of Illinois Launches AI in Medicine Program
To familiarize clinicians with the key concepts and applications of artificial intelligence (AI) in medicine, the University of Illinois Urbana-Champaign has launched a new AI in Medicine Certificate program through an interdisciplinary partnership between the department of bioengineering at The Grainger College of Engineering, the Carle Illinois College of Medicine, and the University of Illinois College of Veterinary Medicine. This self-paced online certificate program, which is intended for physicians, physician assistants, medical students, nurse practitioners, veterinarians, and veterinary technicians, will equip health care professionals with a conceptual understanding of AI and its applications through real-world medical case studies using machine learning models. By the end of this course, students will be able to read literature related to AI in medicine, understand how data-driven decisions are made and assessed, identify and define different types of AI tools and techniques used in medicine, and actively participate in the selection and purchase of AI-based medical software. This program empowers health care providers to more effectively partner with computer science professionals and interact with vendors. The cost for this program is $750, and CME credits are available upon completion. Learn more »
Conversational AI Company Launches Omnichannel Virtual Assistant for Health Care Providers
Enterprise Bot has announced the launch of its HIPAA-compliant omnichannel virtual health assistant platform, HealthAI. This technology aims to use bots in automating and streamlining the scheduling of thousands of patient appointments across the globe. The HIPAA-compliant virtual assistant, which leverages voice, e-mail, and chat-enabled technology, has been developed to make health care more efficient, data-driven, and connected through better utilizing the time and expertise of medical specialists. Enterprise Bot utilizes machine learning to power conversational chatbots, e-mail, and voice bots that can manage customer service queries and provide more efficient, responsive client support. Enterprise Bot’s HealthAI virtual assistant allows for scheduling patient appointments and ensuring meetings and other consultations are arranged for the correct time, and aims to cut out overlapping ones so patients have enough time to change location if necessary. Additionally, HealthAI handles invoice payments, e-consultations, COVID-19 self-assessment, updates of medical records, claims processing, and vaccination enrollment. Furthermore, the virtual assistant comes preintegrated with EPIC. Learn more »
PatientKeeper Integrates its Mobile App With MEDITECH Expanse Hospital EHR System
PatientKeeper, a provider of EHR optimization software solutions, has integrated its mobile app with the MEDITECH Expanse hospital EHR system, enabling health care providers to view inpatient data stored in Expanse on their iOS and Android smartphones and tablets. Expanse is MEDITECH's newest acute care EHR system. Through the PatientKeeper app, physicians have anytime, anywhere access to a comprehensive set of clinical data from virtually any device. In the future, providers will be able to write their clinical documentation in PatientKeeper NoteWriter and store it in Expanse with the patient record. Information currently accessible in the PatientKeeper app includes a patient list, vital signs and input/output measurements, lab results, test results, clinical notes, a medication list, allergies, and order status. Learn more » |
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Mastering the Patient Index
Faced with what seems like the impossible, many health care organizations remain flummoxed on how to ensure patient records are in order. Several experts are here to offer their perspectives on the ideal strategy. Read more »
EHRs, Usability Remain at Odds
Frustration, aggravation, impatience—no, it’s not a description of waiting in line at the DMV. In fact, some clinicians would say spending time in that queue is more productive than working with an EHR. Read more »
How to Build an In-House Coding Department
HIM experts agree that there are eight essential components to a successful homegrown program. Read more »
OIG Data Brief Causes a Stir
Serious allegations made by the government agency have left revenue cycle experts scratching their heads. Read more » |
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Amazon and Google Are Finally Tackling One of Health Care’s Biggest Problems: Unstructured Health Data
An individual’s health care profile comprises many different siloes, and tech companies are now working to organize these disjointed data into something useable, Forbes reports.
Tracking Social Determinants of Health Data in Medicare Advantage
For Medicare Advantage health plans, gathering social determinants of health data is a challenge that involves using both internal and external sources, according to HealthPayerIntelligence. |
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House Removes Ban Impeding Progress on National Patient Identifier
Patient ID Now, a coalition of leading health care organizations, including the American College of Surgeons, AHIMA, the College of Healthcare Information Management Executives, HIMSS, Intermountain Healthcare, and Premier Inc, is pleased that the US House of Representatives has removed, for the third consecutive year, the long-standing ban in its Labor, Health and Human Services, Education, and Related Agencies (Labor-HHS) appropriations bill that has stifled innovation around patient identification for two decades.
This bipartisan movement in the House to remove barriers to accurate patient identification and increased patient privacy has been strengthened in the past year by the effects of the COVID-19 pandemic. Patient misidentification caused challenges for health systems during the pandemic, including thousands of duplicate records created during the vaccination registration process, and disruptions in vaccine availability at provider sites because of inaccurate patient documentation.
Patient ID Now is calling on the US Senate to finally follow suit to protect patient safety and patient privacy—and to bolster the public health system—by removing Section 510 from its Labor-HHS bill. In a letter sent this year to the Senate Appropriations Committee, more than 100 health care organizations called for the removal of this ban. With a third year of bipartisan support in the House of Representatives and overwhelming support from the health care community, this must be the year the Senate takes action to remove this outdated and harmful ban.
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