What Prior Authorization Changes in MA Final Rule Mean for Providers
CMS has released its 2024 Medicare Advantage (MA) and Part D Final Rule, which finalized policies on marketing oversight, prescription drugs, and prior authorization processes. Changes to prior authorization policies are particularly...ACR Recommends Changes to Prior Authorization Proposed Rule
The American College of Rheumatology (ACR) commended CMS for its proposed prior authorization policies but asked the agency to expand its guidance to other utilization management tools and shorten the...Practices Complete More Prior Authorizations, See More Care Delays
Practices are completing more prior authorizations compared to last year and seeing more care delays as a result, according to new data from the American Medical Association (AMA). The AMA recently...Lessons from the NSA’s Independent Dispute Resolution (IDR) Process
Nearly a year since the federal government launched the independent dispute resolution (IDR) process, Becky Greenfield, partner at Wolfe Pincavage, has learned a few things about the No Surprises Act (NSA) and out-of-network claim...TX Physicians Win No Surprises Act Rule Court Case
A federal judge has ruled in favor of the Texas Medical Association’s (TMA’s) challenge of a No Surprises Act rule released by HHS to flesh out the independent dispute resolution (IDR)...From AI to Regulation, Making Progress with the Prior Authorization Process
Prior authorizations are one of the biggest impediments to treating patients, according to Claire Ernst, JD, director of government affairs at MGMA. The Medical Group Management Association, or MGMA, is a trade group representing...Automating Claims Management Processes May Reduce Costs for Providers
Automating claims management processes could help healthcare providers curb the high spending on administrative transactions they saw in 2021, according to the 2022 Index report from the Council for...KLAS: Orgs Value Functionality from Claims Management Vendors
Experian Health and Olive received the highest performance scores in the claims management market, with organizations choosing the vendors for their functionality and pricing, according to a KLAS...How a Better Prior Authorization Process is Rising from FHIR
Given the opportunity, most providers would like to set prior authorizations on fire. One accountable care organization based in the Pacific Northwest is doing just that, in a sense, by leveraging a relatively new health data standard to...Claim Denial Rates as High as 80% for Some Marketplace Payers
Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family...Sponsored by Veradigm
Choosing the Right Partner to Streamline Revenue Cycle Management
The healthcare industry is highly complex and becoming increasingly so because of changes in legislation, regulation, and coverage. A shrinking workforce is further complicating the ability of provider...HHS Reduced Medicare Appeals Backlog by 88% During FY 2022 Q1
HHS ended the first quarter of fiscal year 2022 by reducing nearly 88 percent of the Medicare appeals backlog at the Administrative Law Judge level. According to the Department’s status report...Sponsored by Brault
Preventing Medical Necessity Denials With Clinical Documentation
Healthcare coverage has never been more important, one of the many lessons we’ve learned during the COVID-19 pandemic. And private insurance companies have reaped the benefit of this growing need...Northwell Health to Use AI, NLP to Improve Revenue Cycle Management
Northwell Health has signed a ten-year agreement with an artificial intelligence company to improve its revenue cycle management processes through natural language processing. The healthcare provider...Sponsored by AKASA
Using Intelligent Automation to Improve Healthcare Operations
Healthcare leaders are increasingly looking for opportunities to leverage automation to reduce inefficiencies impacting their revenue cycle and free staff to focus on efforts that improve care delivery...Health Plan Automates Prior Authorization Process Using AI
Guidewell, the parent company to health plan Florida Blue, has partnered with an artificial intelligence company to automate the prior authorization process. Florida Blue will become the first payer...What Is Healthcare Revenue Cycle Management?
While hospitals, small practices, and larger healthcare systems are known for saving lives and treating patients, every healthcare organization needs to develop successful processes and policies for staying financially healthy. That is...Remote Work Propels Electronic Claims Management Adoption
Electronic claims management adoption increased in 2020 as healthcare providers shifted to remote work environments when possible, but they are still leaving billions of dollars on the table in...Sponsored by Brault
2022 Claims Reimbursement Updates in Emergency Medicine
Emergency department providers are still reeling from the effects of the ongoing pandemic. But other important updates are also happening in the background—and they are likely to impact emergency...Sponsored by Zelis
