Fixing Healthcare’s Broken Pre-Authorization Model

Fixing Healthcare’s Broken Pre-Authorization Model

  • November 28, 2016

Among the processes that influence the healthcare revenue cycle, pre-authorization stands out—and not in a good way! Most provider organizations are still managing pre-authorizations the old fashioned way: manually, with paper, pen, fax, and phone. These ad hoc methods of securing and confirming payer approval for non-emergency medical services are error-prone and inefficient, and often lead to denied or rejected claims or, worse, delays in service. Few organizations file claims manually any longer. Why, then, are we still completing, filing, and managing pre-authorization requests as if it's 1980? Technology advancements finally make it possible for providers to standardize and centralize…

Read More
Getting A Grip On Molecular Diagnostics Coverage And Payment

Getting a Grip on Molecular Diagnostics Coverage and Payment

  • November 23, 2016

Molecular Diagnostics (MDx) continue to assume a more prominent role in healthcare, and that means new challenges for payers when it comes to reimbursement, coverage decisions, utilization management, and supporting new care models. Fallon Health is taking these challenges on with an innovative approach to managing a robust MDx program. By focusing on prior authorization, enabling the clinical staff to make informed decisions, and implementing a unique healthcare IT program, Fallon cut review time up to 75%. It's possible your organization could do the same. Learn what Fallon Health did to optimize its MDx program in an upcoming AHIP webinar,…

Read More
McKesson Unveils Pay Coordinating Hub

McKesson Unveils Pay Coordinating Hub

  • November 5, 2016

McKesson Health Solutions unveiled the Intelligence Hub to improve interoperability among healthcare applications.  The platform should make it easier for McKesson systems and third-party solutions to work together. Read the article

Read More
Clinical And Payment Option Released

Clinical and Payment Option Released

  • October 25, 2016

McKesson Health Solutions launched ClaimsXten Policy Management, a new clinical and payment management solution.  The software allows complex policy changes to be updated in weeks instead of months, helping payers achieve ensure fast, accurate payment. Read the article

Read More
Andrei Gonzales Advocates For Experimenting With New Payment Models

Andrei Gonzales Advocates for Experimenting With New Payment Models

  • October 23, 2016

The Affordable Care Act mandated that payers experiment with value-based care models and scale up those that showed promise. That's brought the industry some promising alternative payment models that are now being successfully scaled. The American Journal of Managed Care cornered McKesson's Andrei Gonzales for his take on the ACA's present and future impact on value-based reimbursement. Watch the video

Read More
HealthLeaders Survey Reveals Pre-Auth Pain Points, Ways To Streamline Authorization

HealthLeaders Survey Reveals Pre-Auth Pain Points, Ways to Streamline Authorization

  • October 21, 2016

Pre-service authorization is a tedious, time consuming, and costly process for most providers. And issues related to pre-authorization are a major source of claims denials.

Those are just some of the pre-authorization pain points reported by HealthLeaders Media in a new survey of 158 senior clinical, operations, marketing, and financial leaders from non-profit and for-profit providers nationwide.

The study, commissioned by RelayHealth Financial, ranks pre-service authorization pain points and helps identify areas where improved processes and technology could help streamline payment and reduce denials.

Read the research

Read More
McKesson Health Solutions Unveils ClaimsXten Policy Management

McKesson Health Solutions Unveils ClaimsXten Policy Management

  • October 17, 2016

McKesson Health Solutions launched a new clinical and payment management solution, ClaimsXten Policy Management, to help streamline and automate advanced policy rules and clinically sourced edits. The solution helps promote fast, accurate payment on the first pass, reducing the potential of retrospective recovery and third-party audits and appeals. Read the article

Read More