In my 20 years in healthcare, I have seen numerous changes in financial and operational processes. None has been more disruptive than the increase in the requirement for prior authorization.

Prior authorization is here to stay. Insurance companies are increasing Prior Authorization (PA) requirements for medical services and prescription drugs. As a result, the PA administrative load is getting heavier for healthcare providers.

As a clinician, I understand the importance of palliative care radiation therapy as it relates to pain alleviation and quality of life. The study indicated that as many as 1 in 5 patients who receive RT in their final 30 days of life spent greater than 10 of those receiving treatment.

The OIG’s audits are ramping back up based on their work plan. Obviously, they will be focused on telehealth and supervision, but don’t forget about the integrated basics. Hospitals, providers, and departments don’t have the budget is what I am currently hearing from so many managers, directors, and administrators.

Payer mix is something that is always on the radar for administrators and those in healthcare finance. It refers to the percentage of hospital revenue coming from private insurance companies versus government insurance programs versus self-paying patients. The ideal scenario is more commercial and less uninsured (bad debt/write off). Generally, a commercial plan pays an average of 264% of the Medicare allowable for the same CPT® Read more

There is an enormous amount of money being pumped into “digital health” to solve problems in healthcare from RCM to RPM to Quality. We all know the statistics as to how many start-ups fail (90+%) or run out of runway. PE and VC has allowed more people than ever before to try.

We continue to see the “screws tightening” in healthcare. COVID chaos, delayed screenings, value-based care, a more complex patient, financial difficulty, to alternative payment models, there is much change. Responding to this change must be swift and strategic---mostly different.

It is important to note that this did not sneak up on us or even change from the proposals.However, there will be many disappointed practices and providers who are not ready for the changes on January 1, 2021.

As covered before, the Price Transparency initiative by CMS is only the first step towards redefining healthcare and how all stakeholders engage including patients. Like the mask mandate in the initial stages of COVID, it only works if there is compliance. Also, remember this is a progressive multi year model to include all service by 2024*.