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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.
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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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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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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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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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Extracorporeal Membrane Oxygenation in the Emergency Department
Extracorporeal membrane oxygenation (ECMO) can be lifesaving in selected patients, albeit with a high rate of complications and some long-term effects. Awareness of this therapy and an understanding of potential candidates is the purpose of this article.
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A ‘Normal’ Initial ECG?
The ECG in the figure was obtained from a 30-year-old man who was admitted to the hospital to “rule out myocardial infarction.” His symptoms of chest discomfort were thought to be atypical and unlikely to be due to a cardiac etiology. His initial ECG (not shown) was interpreted as normal. Evaluation, including serial troponins and stress testing, were deemed normal. Before sending the patient home, the ECG in the figure was obtained.
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Peanut (Arachis hypogaea) Allergen Powder-dnfp (Palforzia)
This is the first FDA-approved oral immunotherapy for desensitizing peanut allergy in children to help reduce the risk of allergic reactions.
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The Safety and Effectiveness of Pyrethroid Insecticides as the Battle Against Mosquitoes Continues
There is a statistical association between a urine test suggestive of exposure to pyrethroid insecticides and increased mortality over the subsequent 14 years.