Blog Posts by Tag: Prior Authorization
4 Steps to Optimize the Prior Authorization Process
Prior authorization is a process used by insurance companies or health plans to confirm that certain medical services or procedures are necessary and appropriate before they are performed. This process helps ensure that patients receive appropriate care and that healthcare costs are managed effectively. While prior authorization can help prevent unnecessary medical treatments, it also comes with...
Optum’s Laboratory Benefit Manager Program: Focus on CPT 81479
In 2022, Optum launched its new laboratory benefit management (LBM) program to help health plans reduce unnecessary lab testing through automated payment denial. The LBM program leverages Avalon Healthcare Solutions, which has developed evidence-based lab policies with automated software tools, and the MolDX program, which identifies and establishes Medicare coverage and reimbursement for...
The Role of AI, Analytics, and Automation in Boosting Outpatient RCM Performance
Jeff CarmichaelVP Engineering, XIFIN, Inc. Jared BlankenshipProduct Marketing Manager, Market Expansion, XIFIN, Inc. This blog is part of a series. Read Part 1 here. We recently presented a webinar to the members of The Healthcare Financial Management Association (HFMA):...
Outpatient RCM Gap Analysis for a Better Bottom Line
Sandra Greefkes VP Product and Partner Marketing, XIFIN, Inc. Michael Corley VP Implementations, XIFIN, Inc. This blog is part of a series. Read Part 2 here. XIFIN sponsored a research project which was conducted by The Healthcare Financial Management Association (HFMA) to...
The Importance of Connectivity and Automation to Accelerate Revenue Cycle Management: A Focus on Insurance Eligibility and Discovery
Kouri AndrewsDirector, EDI Operations, XIFIN Mike FauverAVP Health Systems, XIFIN Using disconnected systems to manage the complexity of medical claim billing and revenue cycle management (RCM) can lead to errors, inefficiencies, and rework. This drives delayed reimbursement...
Laboratory Test Claim Denials and Appeals Trends
I recently had the privilege of presenting an in-person workshop in conjunction with The Dark Report Executive War College on Laboratory and Pathology Management. The workshop was on the topic of “Latest Trends and Denials Involving Lab Test Claims.” In this session, I shared XIFIN insights into payor behavior changes and shifting claims processing protocols and highlighted the importance of a...
California Bill Passes that Prohibits Prior Authorization for Biomarker Testing in Cancer Patients
On October 6, 2021, Senate Bill No. 535 was approved by Governor Gavin Newsom and filed with the Secretary of State in California. The bill will prohibit health insurance and health plans from requiring prior authorization for biomarker testing for an insured individual with advanced or metastatic stage 3 or 4 cancer, as well as biomarker testing for cancer progression or recurrence in these...
How to Reduce Retro Authorizations to Improve Reimbursement
Enjoy the following content from our partner, Infinx. The reimbursement landscape for clinical labs and remote patient monitoring has never been so challenging or so precarious. Patient and third-party payor responsibility continues to shift, and there is no end in sight for ongoing changes and increases in government regulations and insurance requirements.In a rapidly changing and consumer-...
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