Biologics and Prior Authorization – A Healthcare Perfect Storm

Biologics and Prior Authorization – A Healthcare Perfect Storm

Physicians trying to prescribe a biologic for a patient often run into a pre authorization perfect storm: A patient excited about a new medication option, a payer less than enthusiastic about the cost of the medication, and clinical staffers frustrated with the prior authorization system. Indeed, in a June article in Practical Dermatology, Dr. Michael Sherling describes a 45-year-old man who suffers from psoriasis so severe he rarely goes out in warm weather. Various topical therapies have proven ineffective, so...

Claims Denied For No Prior Authorization

Claims Denied For No Prior Authorization

When Claims Are Denied For No Authorization   Even as billers work diligently to reduce claims denials, payers are expanding the number of visit types and procedures that require prior authorization—leading to an upswing in denials for some practices. It is estimated that 80% of denied claims have to do with no authorization being obtained, or authorizations being requested improperly. Still, there are types of medicine, such as emergency medicine, who routinely see claims denied for lack of prior approval....

Prior Authorization for Durable Medical Equipment on the Rise

Prior Authorization for Durable Medical Equipment on the Rise

Prior Authorization for Durable Medical Equipment on the Rise   The majority of prior authorization nightmare stories center around patients not being able to receive needed medication, whether for new prescription or because of a change in insurer rules. But medication is not the only thing physicians must submit prior approvals for. Dr. Pierre Manzo recently told the story of a patient trying to replace his CPAP machine because it was falling apart. His insurer wanted him to undergo a...

7 Ways to Speed Up The Prior Authorization Process

7 Ways to Speed Up The Prior Authorization Process

7 Ways to Speed Up The Prior Authorization Process   Obtaining preauthorization is so frustrating and time consuming that many physicians are strongly pushing for complete elimination. Since that scenario is unlikely, we’re pointing out some concrete steps physicians can take to speed up the prior authorization process, making it less costly and exasperating. Hire a prior notification star. Considering how much time your staff spends on precertifications, it makes no sense to put someone inexperienced in charge of this...

Prior Authorization – Solo and Joint Efforts Take Aim at Healthcare’s Pre-authorization Problem

Prior Authorization – Solo and Joint Efforts Take Aim at Healthcare’s Pre-authorization Problem

In the last post in this series, we reported on a pledge taken earlier this year by several payer and provider organizations aimed at improving the prior authorization process. Another, similar effort is under way from the American Academy of Family Physicians (AAFP). It began with a resolution in September 2016 and, after being vetted, was adopted as an official policy in April 2017. In the policy, AAFP says it believes prior notifications should be standardized and universally electronic through...

HIPAA OFFICE – Secure, Compliant Office Productivity Application Suite

HIPAA OFFICE – Secure, Compliant Office Productivity Application Suite

THE PROBLEM HIPAA Office is a secure collaboration platform and suite of office productivity applications that solves two high risk problems faced by physicians today: 1. Doctors have become a primary target for hacking and ransomware attacks, and 2. HIPAA fines are increasing in frequency and severity. HIPAA VIOLATIONS 92% of physicians use text message or inner office instant messaging to communicate among staff and colleagues regarding their patient’s condition, treatment, and order status among other things. Cellular networks are...

Prior Authorization Identified As Top Cause of Physician Dissatisfaction

Prior Authorization Identified As Top Cause of Physician Dissatisfaction

Study Shows That After EHR, Preauthorizations are The Next Factor in Physician Churn   There’s been a great deal of talk in recent years about physician burnout and dissatisfaction. Asked what they’d most like to change, virtually all talk about not being able to spend enough time with patients. But what, exactly, keeps them from that all-important face time? In 2016, the American Medical Association (AMA) sought answers to this question by asking 38 physicians in family medicine, internal medicine,...

Practice Management Software Coupon––PracticeSuite Discount Code

Practice Management Software Coupon––PracticeSuite Discount Code

The best kind of coupons are the ones that save you money, but on something you need and were going to buy anyway. The coupon just sweetens the deal and makes the purchase that much more enjoyable. A step up from this is something the truly gifted shopper can accomplish – to strategically spot coupons for items they need, but that are also on sale––whether it’s 20%-30% off, buy one get one free, or better yet on the clearance rack....

5 Ways to Get The Most Out of Your Patient Portal in The Era of Meaningful Use

5 Ways to Get The Most Out of Your Patient Portal in The Era of Meaningful Use

Are You Getting the Most Out of Your Patient Portal?   If you’re using a patient portal, chances are your patients are getting some pretty convenient features out of it. Even if your portal doesn’t have all the bells and whistles, having a place where patients can access their health data, confirm appointments, and message office staff and their providers can help cut down on phone calls and inefficiencies in office workflow. However, it takes more than a messaging system...

Top Family Physicians in Orange Park FL – Local Family Doctor Review Series

Top Family Physicians in Orange Park FL – Local Family Doctor Review Series

LOCAL PHYSICIAN REVIEW Top Family Physicians In Orange Park FL There are many good physicians in the South Jacksonville, Clay county, Orange Park area, but a few doctors are exceptional in that they specialize in treating patients of all ages – in their role as family doctors. In this series called Local Physician Review we take a look at a handful of the more outstanding Orange Park doctors and ask why and what causes them to rise above the crowd....

Practice Management Hack #4: Gracefully Collecting Past-Due Patient Balances

Practice Management Hack #4: Gracefully Collecting Past-Due Patient Balances

Being paid on time, and often at the time that services are rendered or products are sold, lies at the heart of cash flow, and more generally, business itself. Unfortunately, in the medical profession, billing and payment processes can be overly complex thanks to regulations and plain miscommunication. Whether a patient has been seen and his or her insurance plan does not cover the visit or a life-saving emergency occurs and the patient turns out not to have insurance at...

Practice Management Hacks—Tip #2: Avoid These Costly Appointment Scheduling Mistakes

Practice Management Hacks—Tip #2: Avoid These Costly Appointment Scheduling Mistakes

Five Scheduling Practices That Are Costing You Money To maximize revenue, it makes sense to run your practice as much like a business as possible. At a minimum, that approach involves treating each appointment in your schedule as a product you are trying to sell. That being the case, any scheduling practice that limits your ability to “sell” an appointment is literally costing your practice money. Here are five common behaviors to watch for and attempt to minimize. Providers who...