Articles Tagged With: payers
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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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Payers, Hospitals Disagree About Whether Patient Meets Inpatient Criteria
Payers are refusing to pay claims for gastric bypass, joint replacement, and even cataract extraction. Why? Because documentation in the record does not support the need for surgery.
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Missing Clinical Documentation Reason for Many Claims Denials
More health plans are asking for certain pieces of clinical documentation before paying claims. If it is not there, the claim is denied. What are the specific issues arising?
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Support Medical Necessity or Face Denials for Stat Diagnostic Tests
Claims are sometimes deemed uncollectible after the first attempt to appeal a denial is unsuccessful. This article discusses approaches to help ensure payment.
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Support Medical Necessity or Face Denials for Stat Diagnostic Tests
Claims are sometimes deemed uncollectible after the first attempt to appeal a denial is unsuccessful. This article discusses approaches to help ensure payment.
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Make ‘Peer-to-Peer’ Happen Within 24 Hours, Or Face Denied Claim
Payers are requiring time frames as short as 24 hours for peer-to-peers between the patient’s and payer’s physicians, or they’ll deny the claim. This article discusses several strategies that can make this conversation happen quickly enough to avoid denials.
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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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Team up with providers on pre-cert requirements that are ‘much more aggressive’ — It’s a necessity!
Patient access staffs are challenged to work much more closely with providers’ offices to provide payers with required clinical information and to avoid denied claims.