Hospital Access Management – April 1, 2020
April 1, 2020
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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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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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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.
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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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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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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.