Prior Authorization
Prescription Prior Authorization Systems Explained: CoverMyMeds, Surescripts, Availity & More
A Practical Look at the Systems Behind Prescription Prior Authorizations Prescription prior authorizations aren’t just a paperwork issue anymore—they’re a systems issue. Most healthcare teams today aren’t working in just one place. They’re bouncing between EHRs, payer portals, and electronic prior authorization (ePA) tools just to get a single medication approved. And if you’ve ever…
Read MoreHow to Choose a Prior Authorization Company: 10 Key Factors to Evaluate
Prior authorization remains one of the biggest friction points in healthcare. It slows down patient care, burdens staff, and creates avoidable delays that impact both revenue and outcomes. According to the American Medical Association, over 90% of physicians report that prior authorization delays care, and many say it leads to negative clinical outcomes. At the…
Read MoreTop 10 Prior Authorization Challenges in 2026 (And How Providers Are Solving Them)
Prior authorizations aren’t new, but the pressure surrounding them has never been higher. Between increasing payer requirements, staffing shortages, and rising patient expectations, healthcare organizations are being forced to rethink how they manage authorizations. What used to be a back-office task is now a front-line operational risk impacting revenue, compliance, and patient access. In 2026,…
Read MoreHow to Successfully Outsource Prior Authorizations Without Disrupting Your Revenue Cycle
Prior authorizations have become one of the most time-consuming responsibilities in the healthcare revenue cycle. Between gathering documentation, navigating payer portals, and following up on requests, the process can quickly overwhelm internal staff. For many organizations, outsourcing prior authorizations has become a practical solution. But outsourcing this function requires more than simply handing the work…
Read MoreWhy Prescription Prior Authorizations Continue to Delay Patient Care
Prior authorization has been part of healthcare administration for decades, but in recent years, the burden of prescription prior authorizations has grown significantly. As more specialty medications enter the market and payer policies continue to evolve, providers and pharmacy teams are spending more time navigating approval requirements before patients can begin treatment. For many practices,…
Read More4 Revenue Leaks Costing Rural Hospitals Millions and How to Fix Them
A Practical Revenue Strategy for CFOs Managing Thin Margins and Limited Resources Revenue Loss Is a Process Problem Rural and Critical Access Hospitals operate in one of the toughest financial environments in healthcare. With limited staff, growing payer complexity, and rising administrative demands, efficiency matters more than ever. Yet many hospitals are missing out on…
Read More2025 Healthcare RCM Year in Review & What to Expect in 2026
As 2025 comes to an end, the revenue cycle management environment continues to evolve rapidly. Hospitals and physician groups are experiencing increased payer scrutiny, more complex regulatory requirements, and a growing need for stronger front-end and mid-cycle processes. Below is a recap of the most significant trends in 2025 and a look ahead at what…
Read More5 Best Practices to Clean Up RCM AR and Strengthen Your Revenue Cycle
In today’s challenging healthcare environment, accounts receivable (AR) backlogs can drain cash flow and delay critical reimbursements. Rather than reacting to denials and payment delays, healthcare organizations can benefit from proactive strategies that strengthen the entire revenue cycle. Here are five proven best practices to help clean up your RCM AR, reduce denials, and drive…
Read MoreCase Study: Cass Medical Center Slashes Prior Authorization Denials and Recovers Revenue
Background: Cass Medical Center, a rural provider serving a diverse patient population, was facing a growing challenge in its outpatient clinics: inefficiencies in prior authorization. The internal team faced mounting administrative workloads, inconsistent payer requirements, and delays that often led to claim denials and care disruption. During the first quarter of 2024, these challenges became…
Read MoreThe High Cost of Denials: How Prior Authorization Challenges Are Draining Your Bottom Line
For healthcare CFOs tasked with preserving margins amid tightening reimbursements and rising labor costs, claim denials represent a persistent and costly challenge. One of the most significant and avoidable drivers of revenue loss? Denials related to prior authorizations. According to the Medical Group Management Association (MGMA), prior authorization is consistently ranked among the top administrative…
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