Brian Thompson's murder was chilling, but the social media response of this tragedy was equally shocking, if eye-opening. It shows a massive collapse of public trust in our healthcare system, a system so broken that it bankrupts families, denies life-saving care, and treats death as an acceptable cost of doing business.
Hospitals are facing increasingly burdensome policies from commercial insurers, leading to problems with cash flow and patient safety. Hospital executives think federal regulators need to enact stricter policies that require payers to operate on faster timelines, as well as provide more transparency into their reasons for denying claims.
As technology advances, AI-powered tools will increasingly reduce the administrative burdens on healthcare providers.
Focusing on these areas can help healthcare organizations reduce the incidence of denials, optimize revenue cycle performance and enhance overall patient satisfaction.
Insurers should immediately end their overreach into medical decision-making and work with medical providers and their patients to ensure timely care for all.
Here are six actionable steps healthcare organizations can take to reduce their likelihood of denials and write-offs.
The combination of technology and cross-functional collaboration allows providers to address denials and achieve optimal revenue performance.
Hear executives from Quantum Health, Surescripts, EY, Clinical Architecture and Personify Health share their views on digital transformation in healthcare.
Health systems have been increasingly dropping MA contracts, saying that they cause their organizations to lose too much money and result in dangerous patient care delays. To mitigate this issue, experts think large MA plans need to delegate more utilization management duties to health systems rather than handling it themselves.
Brian Gragnolati, CEO of Atlantic Health System, said that "there's a war going on between providers and payers right now." In his view, payers “are doing everything they can” not to pay providers for the care they deliver. He said insurers have greatly increased their rate of denials and are extremely reluctant to take on risk in value-based contracts.
Compared to government payers, commercial payers take significantly longer to pay hospitals and deny claims at a higher frequency — often without a justifiable reason to do so — according to a new report. Commerical payers have better reimbursement rates than government payers, but providers often have to wait 90 days or more get claims paid by commercial plans.
Health insurers are prohibited from placing unfavorable limits on mental health and substance abuse benefits, and yet, many do. Federal and state regulators are taking aim at these practices and making the enforcement of the Mental Health Parity and Addiction Equity Act of 2008 a key focus.
The future looks bright for the integrated specialty pharmacy model – for health systems, providers, and most importantly, for patients.