Category: Revenue Cycle Management

failing on prior auth reform

Health Insurance Industry Is Failing on Prior Authorization Reform

In theory, prior authorization (PA) exists to ensure that healthcare services are medically necessary and cost-effective. But in practice, it has become a bureaucratic roadblock causing treatment delays, administrative overload, and provider burnout. Despite increasing pressure from physicians, hospitals, patient advocacy groups, and even bipartisan lawmakers, the health insurance industry failing on prior authorization reform […]
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Healthcare Data Breach Notifications

Healthcare Data Breach Notifications for Patients: What You Need to Know

In today’s digital age, patient health information (PHI) is increasingly stored and managed electronically. While this shift improves efficiency and accessibility in healthcare, it also introduces significant data privacy and security challenges. One critical area of concern is healthcare data breach—incidents where patient data is accessed, disclosed, or stolen without authorization. Under the Health Insurance […]
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Denial Prevention vs. Denial Facilitation

Denial Prevention vs. Facilitation: Optimize Healthcare Revenue

In the healthcare revenue cycle, denials are inevitable — but how you manage them makes all the difference. A common discussion in this space centers around Denial Prevention vs. Denial Facilitation, two strategies that, while they may sound similar, have distinct purposes and outcomes. Understanding and effectively applying both can drastically improve your practice’s cash […]
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Medicare Advantage plans benefit

Medicare Advantage Plans Benefit from Expert Medical Billing

As the U.S. healthcare system continues to evolve, Medicare Advantage (MA) plans have seen rapid growth, offering seniors an alternative to traditional Medicare. With more than 30 million beneficiaries enrolled in Medicare Advantage as of 2025, the demand for administrative efficiency and accurate claims processing has never been greater. Medical billing companies play a pivotal […]
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Electronic Prior Authorization

Electronic Prior Authorization: Improving Speed and Efficiency for Physicians

In the intricate dance of healthcare administration, few processes have historically caused as much friction as prior authorization. The traditional, often manual, methods of obtaining approval for medical services and medications have long been a source of frustration for both physicians and patients. Lengthy wait times, administrative burdens, and potential delays in necessary care have […]
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Prior Authorization Burden

9 Ways to Ease the Prior Authorization Burden and Reclaim Your Time

Prior authorization (PA) is a necessary but often frustrating part of the healthcare reimbursement process, and the prior authorization burden it creates is substantial. While insurers use it to manage costs and ensure medical necessity, the administrative burden it places on physicians, billing staff, and patients is immense. A 2022 American Medical Association (AMA) survey […]
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