Relaxing authorization requirements and minimizing authorization delays is really only half of the problem with insurance companies. With or without authorization being required, insurance companies simply deny payment for a plethora of reasons even when authorization is granted. All payers are very clear that obtaining authorization is not a guarantee of payment. This needs to be addressed in tandem with simplifying and streamlining authorization.
This blog in particular has adopted differing views on authorizations. On one hand, authors support networks and authorizations as an important cost cutting measure to nudge patients to better quality, lower cost care at say, an outpatient surgery center rather than a hospital as part of their disintermediation series. On the other hand there are articles like this which are firmly against prior authorizations. Is the take that prior authorization is good in some cases and not others or only in moderation or what?
Again and again Republicans allow private for profit health insurance corporations to accept corporate welfare as they profit in the billions of dollars every quarter.
This public money is best given to Communities, providers and training.
Republicans puppeteer is pre authorized by Christian Nationalists.
The U.S. is the only advanced nation without Universal Healthcare…. passing Medicare for all will save thousands of lives and hundreds of billions of dollars and will prevent 500,000 medical bankruptcy every year.
Nothing worse than an MD / Sr Executive trying to comment on technology 😂
So, for #5 you really should have said “we’re already doing that, actually more than that”.
Maybe not some of the smaller plans but RTA is an important part of the overall system ROI, by reducing “touch time”.
Every major does this.
Secondly, beating up on X12 is like beating up on the stethoscope.
Yes it’s old, but extremely dependable and does its job exactly.
Integration points are built to ingest all or parts of a particular transaction type (e.g. 278) using a wide variety of approaches and can be consumed across practically any platform.
FHIR is cool and definitely a step up for interoperability, but so is an EKG vs a stethoscope.
I won’t bother commenting on the rest of the story…
Relaxing authorization requirements and minimizing authorization delays is really only half of the problem with insurance companies. With or without authorization being required, insurance companies simply deny payment for a plethora of reasons even when authorization is granted. All payers are very clear that obtaining authorization is not a guarantee of payment. This needs to be addressed in tandem with simplifying and streamlining authorization.
This blog in particular has adopted differing views on authorizations. On one hand, authors support networks and authorizations as an important cost cutting measure to nudge patients to better quality, lower cost care at say, an outpatient surgery center rather than a hospital as part of their disintermediation series. On the other hand there are articles like this which are firmly against prior authorizations. Is the take that prior authorization is good in some cases and not others or only in moderation or what?
PA should go the way of the DoDo bird along with PBMs
Again and again Republicans allow private for profit health insurance corporations to accept corporate welfare as they profit in the billions of dollars every quarter.
This public money is best given to Communities, providers and training.
Republicans puppeteer is pre authorized by Christian Nationalists.
The U.S. is the only advanced nation without Universal Healthcare…. passing Medicare for all will save thousands of lives and hundreds of billions of dollars and will prevent 500,000 medical bankruptcy every year.
I’ll refer you to the following from Danny Devito’s 1991 movie Other People’s Money.
Medicare / Medicaid are the buggy whip of healthcare.
https://youtu.be/62kxPyNZF3Q?si=k61B1dYt8NNRCTEY
Nothing worse than an MD / Sr Executive trying to comment on technology 😂
So, for #5 you really should have said “we’re already doing that, actually more than that”.
Maybe not some of the smaller plans but RTA is an important part of the overall system ROI, by reducing “touch time”.
Every major does this.
Secondly, beating up on X12 is like beating up on the stethoscope.
Yes it’s old, but extremely dependable and does its job exactly.
Integration points are built to ingest all or parts of a particular transaction type (e.g. 278) using a wide variety of approaches and can be consumed across practically any platform.
FHIR is cool and definitely a step up for interoperability, but so is an EKG vs a stethoscope.
I won’t bother commenting on the rest of the story…
With all due respect, stick to medicine buddy. 😂