Providers not seeing prior authorization improvement
Amid promises from health plans that they have dialed back their use of prior authorization, hospitals and health systems are not seeing any reduction in their use, say advisers. In April, health plans announced that they eliminated 11% of prior authorizations (PAs) across a range of medical services, representing 6.5 million fewer PAs for patients.…
Prior authorization is draining revenue, which is why automation has become a strategic imperative
Prior authorizations have entered a different era. The process has become one of healthcare’s most expensive administrative bottlenecks, affecting far more than physician practices. Across hospitals and health systems, it slows patient access, adds labor-intensive work, increases denial risk, and puts pressure on reimbursement and cash flow. For organizations focused on growth, margin, and operational…
Navigating payer practices to reduce denials and enhance outcomes
The friction between payers and providers has existed for decades. It’s understandable to an extent. Payers want to reduce expensive and unnecessary treatment, eliminate fraud and lower financial risk. Providers want to be able to make decisions regarding their patients’ care without having to navigate the hurdles of medical necessity, prior authorization and complex payer…