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…
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,…
A recent study on the state of value-based reimbursement found payers are embracing VBR at a faster pace than providers. More than 80% of payers say they are building their networks with providers that have quality measures in place. Read the article
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
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
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
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.
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
McKesson Health Solutions introduced ClaimsXten's Policy Management Module to help payers automate editing processes. The software enables users to layer multiple policy rules into the processing framework to streamline claims processing. Read the article
Today McKesson Health Solutions unveiled ClaimsXten Policy Management, a new clinical and payment management solution that helps payers cut costs and improve “first pass” payment accuracy by streamlining and automating advanced policy rules and clinically sourced edits. Read the news release