Private payers profit by delaying medical claims
Editor's Note Private payers initially deny reimbursement on 15% of claims, only to later approve more than half of those initial denials, according to a national survey of healthcare institutions published March 21 by Premiere, Inc. Additionally, the denied claims on average tend to be more prevalent for higher-cost treatments…
CMS reforms prior authorization to improve care, streamline physician process
Editor's Note The Centers for Medicare & Medicaid Services (CMS) has implemented a final rule reforming the prior authorization process, with the aim to reduce delays in patient care and boost electronic efficiency for physicians, the American Medical Association (AMA) News Wire reported January 23. The Department of Health and…
Coordinating surgical care means precise staff handoffs
In every OR, the complicated dance of surgical care coordination—the series of handoffs between stakeholders throughout the surgery lifecycle—is performed mainly in the background. Those stakeholders include physician offices, schedulers, preadmission testing, insurance verification, vendors, sterile processing, supply chain, anesthesia, and surgical staff. But what does it look like when…
Problems with prior authorization, utilizing health insurance coverage are prevalent, survey finds
Editor's Note This KFF survey from June 2023 found that some six in 10 adults with health insurance have experienced problems when trying to use their insurance, KFF Health News September 29 reports. The problems included denied claims, network adequacy issues, and preauthorization delays and denials. According to the survey,…
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