Healthcare providers (HCPs) today must see more patients, provide more complex medical services, and complete detailed documentation more efficiently. Consequently, there is little time left to deal with billing. An HCPs’ financial stability and their medical practice’s future depend on their medical billing and coding quality.
Author Archives: ACMA
Electronic Prior Authorization Reform: What’s Next?
The legislation will streamline the prior authorization process for the more than 28 million Medicare Advantage members. Medicare Advantage (MA) plans, sometimes called “Part C” or “MA Plans,” are Medicare-approved plans from private companies offering an alternative to original Medicare for health and medication coverage.
4 Tips for Prior Authorization Success
Prior authorizations (prior auths or PAs) are a cost management tool utilized by insurance companies. PAs increase administrative costs for HCPs and create a healthcare obstacle for patients. HCPs depend on prior authorization approvals and insurance payments to remain in business. Healthcare providers (HCPs) must master a productive prior authorization workflow to improve productivity and revenue.
An Essential Guide to Step Therapy
Health insurance companies increasingly employ cost management strategies as more expensive, specialized drugs enter the market. The use of step therapy is one of these cost-control strategies. The goal of step therapy is for patients to try low-cost medications before moving on to more costly ones.
Will Prescriber “Gold Cards” Solve the Prior Authorization Problem?
Imagine a world with fewer prior authorizations. A new Texas law aims to make this dream a reality. House Bill 3459(HB 3459), or the “Gold Card Act,” grants prescribers a “continuous prior authorization exemption” if they have a 90% approval rating on previous authorization requests.
The Players of Prior Authorization
The prior authorization (prior auth, or PA) process itself can be complicated and requires both communication and a cohesive healthcare team. The healthcare team involved in the PA process consists of a provider or physician, the pharmacy, the payer, and the patient. Each player on this team plays a part in successful and positive patient outcomes.
The Evolution of Prior Authorizations
With a solid foundation of prior authorizations, pharmacies are able to bill the medication sooner, physicians are able to focus resources on patient care instead of paperwork, and the patient receives their medication in a timely manner.
The Definitive Guide to Prior Authorization
Gain insights into everything that prior authorization entails in this guide.
What is Traditional Medicare vs. Medicare Advantage?
With so many healthcare options available in the United States, it can be difficult and confusing choosing the right option for you. In this article, we will explain the differences between Medicare vs. Medicare Advantage. To start, Medicare Advantage provides a fixed set of options for you whereas Medicare provides you with a “buffet” style […]
What are Copay Maximizers and Accumulators?
A recent article in the American Journal of Managed Care shed light on copay maximizer strategies among generics manufacturers. But not many patients understand how drug manufacturers are incorporating copay maximizers and accumulators in their reimbursement strategies. As a widespread challenge for patient access, copay accumulators and maximizers eliminate the altruistic nature of the patient assistance […]
