Tag: Medicare Advantage

Prior Authorization Challenges

5 strategies to address Prior Authorization Challenges

Prior Authorization Challenges are a growing hurdle for medical practices dealing with Medicare Advantage plans. Recent investigations reveal concerning trends: improper denials and a lack of transparency from some insurers. This can significantly delay or even block essential care for patients. The Problem with Prior Authorizations Improper Denials: A government investigation found that Medicare Advantage […]
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Prior Authorization Reform: Progress and Positive Steps

Prior Authorization Reform: AMA’s Impact on Doctors, Patients

 Prior Authorization Reform, a lengthy and often frustrating process for payers to control costs, remains a major challenge for doctors. A recent AMA survey of 1,001 physicians found that 89% of physicians believe prior licensure hurts clinical practice. A surprising 33% said the worst things, such as death or hospitalization, were rights-related.  The AMA recognized […]
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Prior Authorization Transformation

How Prior Authorization Transformation Benefits Patients, Providers and  Payers

Prior authorization transformation of consent is a source of worry and concern for everyone involved: patients, members, providers, and payers. What was needed was a structure to coordinate all stakeholders and organize the program. In January 2024, the Centers for Medicare and Medicaid Services (CMS) finalized requirements to expedite the authorization process; this requirement will […]
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Survey: High Initial Claim Denials Impact Healthcare Providers

The Rising Denial Rates in Healthcare Claims Processing Initial Claim Denials: In a new survey conducted by healthcare Company an increased percentage of initial claims are denied by private payers, including pre-approvals for medical claims. Hospitals, health systems, and post-acute care providers may have a difficult time getting paid for medical services. The survey respondents […]
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Streamlining Prior Authorization Final Rule

The Impact of CMS-0057-F on Streamlining Prior Authorization Processes

An improved Prior Authorization Final Rule can result in shorter wait times, fewer delays in the delivery of patient care, and a reduction in costs. CMS has finalized the Interoperability and Prior Authorization Final Rule (CMS-0057-F), which was published by CMS on January 17, 2024. It will reduce the burden on patients, providers, and payers […]
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Benefits-of-Medicare-Advantage

Enhancing Medicare Advantage Benefits for Patients and Providers

The AMGA says that expanding Medicare Advantage benefits would benefit patients, physicians, and others in the health care industry. For Medicare Part C, also known as Medicare Part C, and Medicare Prescription Drug Benefit Program (Medicare Part D), some policy and technical changes have been approved for 2025 by the association. A public comment period […]
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10 Prior Authorization Updates in 2023 

In 2023, multiple entities, such as the Health Insurance Company and health Services Company, declared reductions in prior authorizations. Healthcare Media provided further details on this and additional updates related to prior authorizations in the healthcare sector reported this year. According to a November 13 report from the Medical Group Management Association, 89% of medical […]
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Impacts of Claim Denials on Revenue Cycle

How Claim Denials and Payer Audits Impacts Healthcare Revenue Cycle

Denial rates, notably within Medicare Advantage, are on the rise, impacting both hospital revenue cycles and patient care, remarked the executive director of a Minnesota-based large multispecialty health care organization focused on Revenue Cycle management. Despite the organization reporting a favorable margin this year, it falls short in achieving profits comparable to those of insurers, […]
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AI is set to revolutionize healthcare in 2024!

How AI is Revolutionizing Healthcare in 2024

Anticipate further transformations ahead, with 2024 poised to introduce substantial shifts within the healthcare sector. This period of change will be marked by the rapid proliferation of artificial intelligence, intricately woven into the entirety of the healthcare framework, presenting opportunities to enhance healthcare delivery and elevate patient outcomes. Consider this scenario: Picture yourself as a […]
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