With a constantly changing regulatory environment, health insurance CEOs are facing a complicated environment going into 2018. Here are the top four concerns facing insurance CEOs.
- Delays in Pre-Authorization
Pre-authorization of non-emergency medical services often rely on manual methods, rather than efficient, automated services. Inefficiencies in these processes can lead to delays in pre-authorizations by health plans, and dissatisfaction for both patients and providers.
- Coordination of Benefits
According to the Census, over 20% of the population has more than one health insurance plan in a year. Processing Coordination of Benefit claims is often incorrect due to incomplete information, leading to costly mistakes and inefficiencies for health insurance providers.
- Too Many Emergency Room Visits
The limited availability and high cost of maintaining emergency room facilities are under incredible scrutiny by payers, government, providers and employers. According to a study published in the American Journal of Managed Care, more than 30% of ER visits were avoidable. Reducing this rate will be a major consideration to improve satisfaction for both patients and payers in the coming year.
- High Readmission Rates
There are several social and environmental factors that contribute to patient admission and/or readmission rates to a hospital. Discovering how to reduce readmission rates will be a key factor in reducing costs and improving efficiency for health insurance providers in 2018 and beyond.
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