HealthLeaders Media August 29, 2024
Payer updates and policy changes delay reimbursement; Leaders say automated solutions can help fight back.
KEY TAKEAWAYS
– Carle Health has seen an increase in denials for claim and prior authorizations, typically requiring additional documentation or information.
– Revenue cycle partners meet monthly to review denials, making note of any trends and monitoring progress.
– Some trends they have noticed include interoperative CPT code changes and those to payers own rules and regulations.
The tug-of-war between providers and payers over prior authorizations is a consistent and costly issue.
While Illinois-based Carle Health System does a good job of managing this issue in the front-end, it takes 36.5 days to appeal a denied prior authorization request.
“Last year, we were somewhere...
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