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Prior Authorization

How Times of Crisis Spur Needed Change in Healthcare Delivery

by Christina Perkins, VP Product Management and Strategy for NaviNet, NantHealth 08/04/2020 Leave a Comment

How Times of Crisis Spur Needed Change in Healthcare Delivery

As the COVID-19 pandemic continues to change healthcare operations in the world, foundational systems are being adapted to meet these new demands. Sometimes it takes extreme circumstances to see the cracks in a system. COVID-19 has exposed areas with more room for improvement in the healthcare system, such as optimizing operational efficiency. Organizations and individuals have changed their interactions, processes, ways of working, treatment plans, and even foundational technology. As the
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Cohere Health Launches with $10M to Increase Transparency Across Care Journey

by Fred Pennic 07/16/2020 Leave a Comment

Cohere Health Launches with $10M to Increase Transparency Across Care Journey

What You Should Know: - Boston-based health IT start-up Cohere Health announced the official launch of its company with a $10 million Series A funding round led by Flare Capital Partners. - The company’s patient journey-focused platform improves the notoriously difficult prior authorization process and replaces an existing patchwork of legacy, siloed processes, and antiquated technologies that contribute to the enormous administrative burden for physicians and health plans. - The end
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4 Ways Healthcare Organizations Can Establish Partnerships to Drive Innovation

by Eric Nilsson, CTO, The SSI Group 07/14/2020 Leave a Comment

Nebraska Medicine’s experience points to four ways healthcare organizations can establish partnerships with vendors that drive innovation and performance excellence.

With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment. Take Nebraska Medicine, for example. In the early 2000s, the health system created multidisciplinary committees to boost revenue integrity and adopted new revenue
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Why Outsourcing is the Best Approach to Prior Authorizations

by Mohammed Ahmed, VP, Authorizations and Sales Enablement at Availity 05/11/2020 Leave a Comment

Why outsourcing is the best approach to prior authorizations

Doctors didn’t attend medical school to spend their waking hours managing or waiting for prior authorizations (PA), but these days it feels like that’s all they are doing. A recent American Medical Association survey found that 90 percent of responding physicians believe that the “administrative burden related to PA requests has risen in the last five years, with most saying it has ‘increased significantly.’” As healthcare continues its acceleration toward value-based reimbursement models,
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CVS Health, UCLA Health Partner to Bolster Hospital Capacity for COVID-19

by Jasmine Pennic 04/17/2020 Leave a Comment

CVS Health, UCLA Health Partner to Bolster Hospital Capacity for COVID-19

What You Should Know: - CVS Health announced it is working with hospitals and providers, including major systems like UCLA Health, to support their solutions for creating much-needed hospital bed capacity during the pandemic. - Hospitals around the country are expanding their capacity to meet the anticipated needs as a result of the COVID-19 pandemic. - Current estimates project that hospitals nationwide need to increase capacity by more than 36,000 hospital beds. - In addition,
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3 Ways to Build a Back-to-Basics Approach to Revenue Cycle Management

by Deborrah Short Rodrick, The SSI Group 03/23/2020 Leave a Comment

3 Ways to Build a Back-to-Basics Approach to Revenue Cycle Management

Sixty-nine percent of healthcare revenue cycle leaders say they will put more money toward technologies that boost revenue integrity, eliminate human error and unlock greater efficiency in the year ahead, an HFMA/Navigant analysis found. But for many organizations, the biggest untapped opportunity to improve performance comes down to a single word: data. For all the buzz at about the ways in which digital innovation and automation could transform revenue cycle management, healthcare
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HHS Issues Strategies & Recommendations to Mitigate EHR-Related Clinician Burden

by Fred Pennic 02/24/2020 Leave a Comment

Physician Burnout_Cognitive Overload Documentation Overload

- HHS issues new report outlining the key sources of EHR-related burden, as well as strategies and recommendations to achieve burden reduction goals for healthcare providers. - The HHS report reflects additional input from the more than 200 comments submitted in response to the draft strategy and recommendations. As part of the ongoing efforts to strengthen the relationship between patients and their doctors, the U.S. Department of Health and Human Services (HHS) issued
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CAQH CORE Approves Two-Day Rule to Accelerate Prior Authorization Process

by Jasmine Pennic 02/06/2020 Leave a Comment

CAQH CORE Approves Two-Day Rule to Accelerate Prior Authorization Process

- CAQH CORE participating organizations--consisting of healthcare providers, health plans, vendors, government entities, associations and standard-setting organizations--have come together to pass a national two-day time limit for plans to request additional info and make final decisions on prior authorization requests. - Prior authorizations are the most costly, time-consuming administrative transaction for providers. And when the process takes too long, it can delay patient care. - Over
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Roundtrip Taps Redox to Provide Complete View of Patient’s Transportation Journey

by Fred Pennic 01/22/2020 Leave a Comment

Roundtrip digital transportation marketplace

- Redox partners with Roundtrip digital transportation marketplace to ensure patients get to appointments. - With Redox ensuring total interoperability across healthcare data source systems, Roundtrip can compile a complete view of a patient’s transportation journey between care settings and offer insights to improve outcomes.Roundtrip, a digital transportation marketplace for providers and patients, announced today its strategic partnership with Redox, a healthcare integration platform for
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Top 60 Health IT/Digital Health Mergers & Acquisitions in 2019

by Fred Pennic 12/27/2019 Leave a Comment

Kareo Sells Managed Billing Services Business to Health Prime International

- From Google's acquisition of Fitbit to Philips acquisition of Carestream Health's health IT business, here is a look at some of the biggest health IT/digital health mergers & acquisitions in 2019 by each quarter. Q1 M&A Activity Johnson & Johnson Acquires Auris Health for $3.4B to Expand Digital Surgery Portfolio Johnson & Johnson acquiresAuris Health, a developer of robotic technologies for $3.4 billion in cash. Auris Health is a privately-held developer of
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