The 2020 Election results were considered by many to be one of the most important to the U.S. Not only were there the highest number of votes, but several looming healthcare issues such as COVID19, the opioid crisis and drug pricing were top of mind for many Americans. President elect Biden will be inaugurated later this […]
Author Archives: Amanda DeMarzo
What is Managed Care?
Managed care is a method of optimizing patient health using evidence-based healthcare strategies and resources. The purpose of managed care is to enhance the quality of healthcare for all patient populations. Managed care revolves around the collaboration of health insurance plans and healthcare providers. Managed Care includes healthcare plans that are used to manage cost, […]
Pharmacy’s Role in the Prior Authorization Process
Prior authorization processes continue to grow year after year. With an ever-growing need to decrease costs, many health plans are increasing the number of prior authorizations required for both medical and prescription benefits. Prior authorizations are utilization processes used by insurance companies to determine coverage for healthcare. What are the steps of prior authorization? There […]
Summary: Prior Authorization Changes Driven by the Covid-19 Pandemic
The severity of the COVID-19 pandemic has changed the way hospitals can manage the administrative burden of prior authorization due to an increased demand for direct patient care services. Insurance companies are asked to waive prior authorizations for a variety of medications and services during this time. The American Medical Association designed policies to reduce […]
What is Prior Authorization?
Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered. This means if the product or service will be paid for in full or in part. This process can be used for certain medications, procedures, or services before they are given to the patient.
5 Ways Your Field Reimbursement Team can Stand Out in 2021
Field reimbursement and patient access continues to be at the forefront of everyone’s mind as we approach 2021. The politicians are noticing how healthcare can make a lasting impact on Americans and they will continue to push for healthcare legislation. Patient advocacy and ensuring patient access will be bigger than ever in 2021. Therefore, field […]
ROI of a Prior Authorization Specialist
Prior authorizations (PAs) can be a costly step that gets in the way of patient access. Data from EviCore Healthcare shows that on average, each prior authorization costs $11 for providers and that it has a detrimental impact on patient adherence where approximately half of patients struggling to adhere, especially with specialty products. So, why […]
Calling All Patient Advocates!
Have you been working with patients to re-evaluate their commercial health plan or Medicare plan? As a patient advocate, now is the time. Open enrollment for 2021 is underway and ends in a few short weeks! For Medicare patients and all patient advocates helping during this time, the enrollment deadline is December 7th! For commercial […]
5 Mistakes Field Reimbursement Teams Cannot Afford to Make
1) Not Listening to HCP needs Health care providers have direct patient interaction and drive the access to medications. Therefore, field reimbursement teams should be in tune with their needs and their frustrations as the first gatekeeper to the medication is the provider. Education and assistance are keys to having the support system for the […]
Importance of the HIPAA Security Rule
Patient confidentiality is one of the most important aspects between a healthcare provider and a patient. Confidentiality strengthens the trust of a patient-physician relationship and ensures the quality of care and patient autonomy. Prior to the implementation of HIPAA, the healthcare industry lacked a set standard or requirements regarding the protection of health information. Simultaneously, […]
