Medical Necessity

New federal guidance seeks to clarify reimbursement of COVID-19 testing and vaccinations

Federal agencies have issued new guidance intended to make it easier for healthcare providers to receive reimbursement for administering COVID-19 tests to insured individuals and for giving vaccinations to the uninsured.

Nick Hut March 1, 2021

Front-line stories: How today’s prior authorization processes create a burden of waste for providers

As hospitals continue to struggle with razor-thin margins, they should actively identify activities that create financial burdens for them without delivering value to patients. One health system’s stories of administrative waste due to prior authorization processes show why this activity should be be high on their list.

Alan S. Kaplan, MD, MMM, FACPE February 19, 2021

Amid some resistance by healthcare workers, COVID-19 vaccine delivery continues to roll out

Amid the early rollout of COVID-19 vaccines, provider organizations are urging reluctant clinicians and other employees to take the inoculation.

Rich Daly December 16, 2020

Hospitals begin to receive first doses of COVID-19 vaccines

Hospitals and other providers that were prioritized in state COVID-19 vaccine distribution plans have begun to receive and administer their first doses.

Rich Daly December 15, 2020

Azar warns about hospital overcrowding if the public overreacts to the coronavirus

People could swamp hospitals if they overreact to the novel coronavirus, the senior federal healthcare official warned Congress this week.

Rich Daly April 1, 2020

Auth-DP software helps streamline prior authorizations to reduce denials

A leading revenue cycle technology company talks about how its innovative prior authorization software streamlines the process of checking for, obtaining and following up on prior authorizations, saving organizations millions in avoided denials.

HFMA January 2, 2020

The price of innovation: 3 steps for managing specialty drug costs

Health plans can help control the cost of specialty drugs by communicating with providers about appropriate treatments, integrating coordination of pharmacy and medical benefits and implementing fixed-price models.

Emad Rizk, MD December 2, 2019

Administrative prior authorization requirements increasingly used to steer patients to lower-cost settings

Hospital finances could be significantly impacted by UnitedHealthcare’s expansion of site-of-service prior authorization requirements going into effect Nov. 1.

Chad Mulvany, FHFMA November 5, 2019

Enjoin: Enabling Holistic Clinical Documentation Improvement

James Fee, MD, CEO of Enjoin, discusses the importance of holistic clinical documentation to realize success with existing fee-for-service payment models, as well as value-based care and population health initiatives.

HFMA October 1, 2019

The price of precision medicine: 3 ways for health plans to manage genetic-testing costs

With spending on genetic testing expected to grow significantly, health plans can use three steps to get a handle on costs.

Emad Rizk, MD August 1, 2019
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