Utilization management (UM) reviews are a component of the value-based care approach. They aim to determine if the care provided to patients is appropriate, efficient, and linked to improved patient outcomes. The UM processes of insurance companies include prior...
Health insurance carriers require prior authorization (PA) as a condition of payment for many services. Payers use PA to determine if certain medications, products, treatments or services are medically necessary before they are prescribed/rendered to beneficiaries....
One of the administrative challenges that physicians have to deal with is obtaining prior authorizations for prescriptions and testing. This has led to an increase in the demand for insurance authorization services in recent years. Prior authorization is major problem...
Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is repeatedly interrupted during sleep. The involuntary pause in breathing can result either from a blocked airway or a signaling problem in the brain. Treatment for this condition...
Healthcare providers and medical coding companies had a one-year grace period for ICD-10-coded medical claims. According to a recent report in Physicians Practice, claims statistics showed improvement in Q4 2016 after the end of the ICD-10 grace period in October...