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Description
2024 Prior Authorization Process For Medical Providers | Prior Authorizations are a cost containment strategy that third-party payers leverage to control costs, restrict patient access to services, testing, and medications, and ultimately discourage medical providers from ordering unnecessary medical treatment. Prior authorizations are a major source of headaches for healthcare providers nationwide. Despite the intention to control costs and ensure appropriate care, the prior authorization process has been criticized for its enormous administrative burden, potential delays in necessary medical treatment, and added complexity for healthcare providers.
Striking a balance between cost control and efficient patient care remains a major challenge in the healthcare industry. Join us for an insightful 60-minute webinar as we take a deep dive into the complexities of the Prior Authorization process, discuss the pearls and pitfalls, define medical necessity requirements, and demystify the intricacies of obtaining prior authorizations, ensuring a smoother workflow and higher approval outcomes in 2024.
Learning Objectives
- Understand the major Prior Authorization Updates for 2024.
- Recall medical necessity and its critical role in the Prior Authorization approval process.
- Identify which insurance payers require Prior Authorizations in 2024.
- Recall methods for obtaining Prior Authorizations in 2024.
- Recognize common challenges experienced when obtaining Prior Authorizations.
- Understand how to escalate and appeal Prior Authorization denials in 2024.
Areas Covered
- Discuss the major Prior Authorization Updates for 2024.
- Explore the 2024 Prior Authorization requirements for Medicare Advantage Plans.
- Define medical necessity and its critical role in the Prior Authorization approval process.
- Explore the regulatory landscape for Prior Authorizations in 2024.
- Identify which insurance payers require Prior Authorizations in 2024.
- Discuss methods for obtaining Prior Authorizations in 2024.
- Review common challenges experienced when obtaining Prior Authorizations.
- Outline successful strategies to overcome challenges with obtaining Prior Authorizations in 2024.
- Discuss how to escalate and appeal Prior Authorization denials in 2024.
- Share best practice compliance tips for Prior Authorizations in 2024.
Background
Prior Authorizations are a critical cost containment strategy that third-party payers leverage to control healthcare expenditure costs, which can lead to frustrated medical providers, delayed medical treatment, delayed or missed diagnosis, etc.
Why Should You Attend
Prior authorizations are a major source of frustration and headaches for healthcare providers nationwide. In this session, we deeply dive into the nuances of Prior authorizations and how to challenge and escalate denials successfully.
Who Should Attend
- Medical Coding Specialists.
- Medical Billing Specialists.
- Medical Auditing Specialists.
- Private Practice Physicians.
- Managed Care Professionals.
- Operations Leadership.
- Practice Administrators.
- Office Managers.
- Compliance Officers/Committees.
- American Academy of Professional Coders.
- American Health Information Management Association.
- Medical Group Management Association.
- Health Care Compliance Association.
- Medical Association.
Speaker
Toni Elhoms, CCS, CPC, CPMA, CRC, AHIMA-Approved ICD-10-CM/PCS Trainer is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Toni's expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. She serves as ACE’s Senior Consultant and conducts training and educational seminars across the country. With well over a decade of industry experience, Ms. Elhoms has led and supported hospital systems, universities, physician practices, payers, law firms, government agencies, and other entities on coding, billing, and compliance initiatives.
Toni is a frequent contributor to various media outlets, a highly sought-after conference speaker, and a regular guest on industry podcasts. She frequently serves as an expert and consulting witness in both civil and criminal litigation matters. Ms. Elhoms was appointed as an editorial advisory board (EAB) member for The Coding Institute (TCI) in 2020. She created and regularly hosts the Alpha Coding Podcast series (rated a top industry podcast) to share her industry Pro-Tips. She is a regular volunteer and mentors a network of Revenue Cycle Management (RCM) and Health Information Management (HIM) professionals across the United States.