Matt Kraemer, administrator of Northern Arizona Healthcare in Flagstaff, joined Becker’s to discuss how prior authorization is affecting his practice.
Question: What reimbursement issues are you currently facing?
Editor’s note: This response was edited lightly for clarity and length.
Matt Kraemer: Reimbursement issues we are currently faced with today in the ASC setting do not seem to be novel, but a continuation of yesterday’s challenges. Claim denials continue due to prior authorization errors or unforeseen procedures completed during cases not included in the prior authorization list. This leads to a process of resubmittals and appeals, which require staff and time, and sometimes result in no reimbursement for the case. Expanding no prior authorization required lists are assisting with this, however continue to trail the trend.
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