Hospital
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Doctor Wins Defamation Suit Alleging Improper Peer Review Process
Responding to allegations of physician misbehavior is a challenge. A recent court case holds lessons for what can go wrong when a hospital does not follow best practices or even its own internal policies.
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Automating Auths: Not as Simple as It Sounds
If electronic prior authorization was implemented fully across the industry, the extra hours of work and high costs could be reduced significantly.
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When It Is Life and Death, No Time to Wait for Authorization
Denied claims for urgent, medically necessary procedures are no laughing matter. Patient access staff have to appeal each denial, a time-consuming and expensive process. A New York law states that if a patient presents with unexpected complications or requires additional services in the course of treatment, a health insurer will no longer be able to deny payment due to lack of prior authorization.
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The Pushback to Burdensome Authorization Requirements Has Begun
It is hard to dispute the fact that prior authorization requirements place a heavy burden on both patients and providers. Yet the number of services and medications requiring auths continues to increase. Read on to learn about several trends.
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Patient Care Goes Forward as Planned: ‘You’re Good to Go’
Patients tend to become anxious when scheduled care is cancelled due to authorization holdups. This happened so often in one system that a decision was made to change the process. If the payer takes too long to give an answer one way or the other, things go forward as planned anyway.
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Automation, Artificial Intelligence Future of Patient Access Authorizations
A revenue cycle operator explains how his department is breaking free from old-fashioned practices and moving toward automation.
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Evidence Shows Prior Auth Requirements Hurt Patient Care
Complying with health insurance companies’ prior authorization requirements is demanding ever-increasing resources from patient access. The authors of multiple recent studies found these requirements also stop patients from receiving needed — and sometimes life-saving — medical care.
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Ethics Curriculum Feasible for OB/GYN Faculty
Much ethics education focuses on students and residents, but practicing physicians also need ethics expertise. An ethics and professional curriculum was piloted for faculty in obstetrics and gynecology.
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Testing Detects Hormone Changes Signaling Menopause
Results of a new study established that levels of anti-Müllerian hormone (AMH) can predict when a woman’s final menstrual period will occur. By measuring AMH levels, clinicians have an indicator of how many eggs a woman has remaining. The results of the research were part of the scientific evidence presented to the FDA for the 2018 approval of MenoCheck, an assay kit used to determine menopausal status in women ages 42-62 years.
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Research Reinforces Importance of Tailoring Hormone Therapy
Data from research that examined the use of different oral and transdermal hormone therapy agents and their associations between heart fat accumulation and atherosclerosis progression indicated that in comparison to transdermal estradiol patch, oral conjugated equine estrogen appears to slow the adverse effects of increasing paracardial adipose tissue on the progression of atherosclerosis.