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 significant 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 significant 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 significant 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 typical challenges experienced when obtaining Prior Authorizations.
• Understand how to escalate and appeal Prior Authorization denials in 2024.

Areas Covered

• Discuss the significant 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 significant 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.