The 2023 ACMA conference has concluded, and Harmony was excited to participate in the annual show. The energy and enjoyment for in-person connection was apparent. It’s hard to quantify how meaningful it is for us to connect with our business partners, friends, and colleagues in these settings. Harmony is excited to invest in these meetings and we look forward to the next opportunity.
What did we hear? Harmony understands that organizations continue to feel the impact of the labor shortage in healthcare. Institutions are implementing creative solutions to tackle this national challenge: remote case management, non-licensed work being offloaded to trained staff, leveraging technologies to reduce readmission rates, and global resource employments.
Denials are an ongoing challenge for hospitals. From the C-Suite to the staff that are tasked with resolving them, the ever-changing rules and regulations require consistent care and attention. The conventional thinking has always been that consistent and clear documentation should lead to overturns. The reality is that payers are inconsistent in their rationale for denials and organizations will need to be creative in their usage of legal arguments, diligent review of payer contracts, in addition to their consistent and clear clinical rationale.
In 2022 the OIG completed a study regarding Medicare Advantage Organizations (MAOs) Denials of Prior Authorization Requests. The study showed concerning findings: “…among the payment requests that MAOs denied, 18 percent of the requests met Medicare coverage rules and MAO billing rules. Most of these payment denials in our sample were caused by human error during manual claims processing reviews…” (Grimm, 2022).
These types of studies highlight the challenges our providers are facing. Staffing shortages, inadequate tools, and the lack of continuity with payers causes a repeated cycle of frustration that exacerbates clinician burnout and is detrimental to the patient experience.
We live in an imperfect world that has imperfect systems. Healthcare reimbursement and patient care has come a long way but there is much to do still. Harmony is making necessary investments to bring new solutions to the forefront of the labor shortage challenge. Harmony is committed to helping bridge the gap so hospitals can ensure they are accurately paid for the care they are providing patients while ensuring the best outcomes.
