Stating Your Case – Best Practices for Challenging Prior Authorization Determinations and Denials

With the COVID-19 declared public health emergency (PHE) now behind us, many health care providers have already returned to business as usual. While there are lingering effects of the PHE, such as increased costs related to supply chain-related issues and staffing shortages, payors have, for the most part, resumed pre-PHE operations by eliminating most of the waivers and flexibilities. Unfortunately, business as usual in revenue cycle management also means the return of an abundance of payor audits and appeals – even though some would argue they really did not go away.