Pre-Payment Review

Featuring clear healthcare costs!

I have previously written about the medical loss ratio rules the roost when it comes to healthcare profits for Big Health companies.

There's been a lot of focus on prior authorization, and it hasn't gone well for them. People are upset when their treatment isn't authorized. However, it is a truism that, for Big Health, they can't just go around paying out claims willy-nilly, because they might spend more than they had planned on, and that would eat into their profits.

They have a mechanism to address this, which isn't prior authorization. Prior authorization is asking for permission before you provide a medical service. That is frustrating for patients.

The new strategy, it seems, is to demand a review after the service has already been provided, but prior to paying the practice. This is Better! it puts practices in the uncomfortable position of already being out the money for the medical service, but put them on the line whether payment will happen or not!

There is some great c…