Healthcare Uncovered Ep 2: Denied Requests: Medicare Advantage and the Rise of Prior Authorizations

Doctors are having to do more and more prior authorizations every year. In fact, almost 80% of practices say prior authorization frequency is increasing. Why? The answer is NOT obvious.  
I’m lifting the curtain on what’s really going on in this week’s episode of Healthcare Uncovered. 
 
In this episode I cover:  
-Why prior authorizations are growing  
-Why they are the #1 administrative challenge for practices  
-Alternative sources of patient revenue 
 

Doctors, there are alternatives, you just need to look. I break it down further in Episode 2 of Healthcare Uncovered.  
 
Sponsored by Nomi Health.

[fred]

Technically, MA does have a premium. It's the Part B premium you still have to pay to Medicare.

[cate]

Have you heard what is going on with Anthem!? Getting authorization for self funded plans and then they are turning around and wanting medical records for prepayment....cause a trend in our AR currently lowing waiting on this payer to pay...ridiculous

[vikingwind]

Unfortunately, MA may have a place in the system as it is today. Many retired folks cannot afford a supplement plan. While MA is challenging, it is far better than the Socialized medicine systems in the UK or Canada where the "First come first served" policy have cost many their lives. I enjoy your videos. Thanks!

[unebonnevie]

Pretty soon prior authorization required for stool/urine sample by the insurance companies!

[hadassah]

Its also the untrained help they hire that dont do their job or/and dont know what their doing or how to do it. Also its happening to patients like myself saying it is denied! I had a dentist office send me a bill A YEAR LATER saying it was denied and said i had to pay!!! YEAH RIGHT, that wasnt happening!!! Anyway it took almost a year fighting with this dept because i had proof they NEVER SENT THE ORIGINAL BILL IN And i had proof from the insurance company who said they were not paying because it was over a YEAR OLD! and the Dentist (who was a good guy) had no idea that it was his employees!!!! He thought it was the insurance company!!!! SO sometimes its the OFFICE PEOPLE!!! Trying to blame the insurance for not getting paid and then they said i was responsible! The people you have working now, MOST ARE IRRESPONSIBLE AND THEY DONT CARE!

[nursestech]

Don’t you feel that MA Plans should actually be better and more streamlined than traditional MediCare? Here is why, if the MA Plan is effectively managing the care of their population, shouldn’t a much larger present by actually MANAGED. What I mean is shouldn’t they be in a Case Management program that provides them a RN or Care Coordinator ensuring that they’re not only getting their preventative screenings but also analyzing their needs and aligning to their benefits? Then assisting them getting a referral or something basic like an Rx refill or lab test?
The MA Plans are obviously “kicking the can down the road” and not addressing what is needed for the Majority of their members.
Btw, I’ve done the informatics for a couple of HP’s and the largest MSO with multiple MA Plan contracts with over 1.5 million lives. So I can state. An MA Plan that has 10, 000 members rarely has more than 1500 members in active CM, DM or TCM programs.

[liberoAquila]

I think traditional Medicare has some prior authorizations too but not nearly to the level MA has. I don't understand how once per year vitamin D screening is not covered since we know that Vitamin D deficiency is common especially in northern climates and among people of color.