Current workflows between payers and hospitals and health systems related to receiving and responding to audit and authorization requests are ripe with inefficiencies. Whether receiving requests from the Centers for Medicare & Medicaid Services (CMS) or commercial payers, healthcare audit teams understand there is much opportunity for process improvement. They also understand that such inefficiencies not only impact the organization’s bottom line but can ultimately lead to compromised care delivery.

At a time when technology like electronic medical records and telemedicine are commonplace, how is it that some healthcare organizations are still drowning in paperwork when responding to Medicare Fee-for-Service audit requests and prior authorizations? Join us to learn how you can affect process changes that can yield dividends for not only your organization, but – more importantly – for your patients.

Although CMS and commercial payers have worked to implement programs supporting the electronic submission of medical documentation (esMD) and fulfillment of Additional Documentation Requests (ADRs) electronically, there is still much work to be done.

A December 2020 AMA physician survey yielded some surprising findings related to the effects that prior authorization processes had on their patients and their practices. Additionally, legislative changes underway will impact prior authorizations for Medicare-related care delivery.

There’s no doubt that the healthcare industry is focusing on process improvements around prior authorizations and pre-claim review initiatives. In this session, we discuss what’s happening now, what’s coming in the near future and what actions your organization should be taking to prepare.

Learning objectives

1. Identify opportunities for improvement of audit and prior authorization processes within your organization
2. Mitigate the effects of prior authorization delays on patient care delivery
3. Understand upcoming regulatory changes and what they mean for your organization
4. Identify technology that can help streamline denials management workflows related to audits, appeals and authorizations
5. Create an action plan for addressing denials management process improvement