In a recent government meeting, officials discussed critical issues surrounding healthcare payment variances, particularly focusing on authorization-related denials and patient financial engagement strategies.

A significant finding revealed that 50% of authorization-related denials stem from outpatient authorizations, highlighting a need for improved tracking and management of these authorizations to prevent timely denials. Emergency department (ED) visits were identified as a major contributor, with 58% of denials linked to difficulties in obtaining accurate patient information upon arrival.

The meeting emphasized the importance of enhancing patient financial engagement, particularly through the expansion of collection programs to include coinsurance and deductible collections. Officials noted that Georgia's status as a non-expansion state presents challenges, but there is an opportunity to implement a more robust financial assistance program. This could involve partnerships with Medicaid eligibility vendors to assist uninsured individuals in enrolling in Medicaid.

The discussion also touched on the need for consistent insurance verification at the time of registration in the ED to reduce timely filing denials. Credentialing denials were noted as a low-impact area, with recent issues attributed to provider changes that have since been resolved.

Financial performance metrics were reviewed, indicating that avoidable write-offs account for 1.2% of net patient service revenue, slightly above the industry benchmark of 1%. The meeting concluded with a call for improved reporting systems to identify trends and implement corrective actions effectively.

Overall, the meeting underscored the necessity for healthcare organizations to refine their processes to minimize denials and enhance patient financial interactions, ultimately aiming to improve revenue collection and patient care outcomes.