Prior authorization is a utilization management process used by some health insurance companies for determining if the patient’s health policy covers a prescribed services, like procedures, tests, or medications, before services are rendered. While intended to control healthcare costs, prior authorizations can be a significant burden on healthcare providers and can delay patient care.
No Surprises Act (NSA) protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
Top At-Risk Conditions and utilization spikes that healthcare leaders and stakeholders across the industry must prepare to proactively address in the upcoming year highlight the recently released, 2023 State of Health – In The Aftermath Report. The report also presents predictive findings and explores the top contributing factors of many utilization increases.
Understanding the Vital Role, Challenges, and Opportunities of Independent Medical Review Services, offers a behind-the-scenes look at internal and external appeals, reasons why accredited IROs reduce risks, and a crash course on newer review services, such as the independent dispute resolution process that’s part of the No Surprise Act (NSA) surprise billing regulations.
Psychiatrist shortage by the numbers: The current workforce of about 45,580 psychiatrists must increase by 2,800 to meet today’s demands for psychiatric care. This works out to a 6.4 percent shortage. By 2025, that shortage could be as high as 6,090 psychiatrists, or 12 percent, according to the U.S. Department of Health and Human Services.
There are numerous health-related challenges facing rural areas of the U.S., including geographic isolation, an aging population, and a shortage of providers and hospitals, especially as rural hospitals close at unprecedented rates.