Sep 10, 2021 | Medicaid Managed Care
7 out of 10: Medical directors we talked to this week who are pushing more “gold carding” to limit pre-authorization cost and reward practices that are reliably ordering the right tests and treatments, communicating decisions, and getting the right outcomes. Gold Card: But you need to understand the MCO’s point of view on when to pull back oversight, and when to keep it. Just because the payer approves 99% of your requests doesn’t mean they should remove pre-authorization requirements. Take oncology. There’s “pre-authorization,” but sometimes that PA is really more in place as a...
Sep 3, 2021 | Managed Care Friday
60: “Percent of the time…it works…EVERY time,” or so said Paul Rudd’s news character in Anchorman about his potent cologne, which Ron Burgundy sternly replied in a way that only Will Ferrell can, “Well that just doesn’t make sense” – which is of course logical and funny to say out loud, but Rudd’s stat isn’t so illogical if you think about it. In baseball, 60% gets you in the Hall of Fame, in high school it gets you a diploma and in healthcare it can get you “coverage” for novel treatments and increasingly that better-than-half goal will be part of more and more outcomes-based contracts,...
Aug 31, 2021 | Medicare, Physician Fee Schedule
Surgery: Recent developments in surgery includes mixed Medicare FFS reimbursement trends and stable Medicare spending. Click to read more.
