How Rev Cycle Leaders Leverage Automated Prior Auth Solutions

HealthLeaders Media August 29, 2024
Jasmyne Ray

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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