Chris Roy, business development executive at Hutchinson, Kan.-based The Summit, joined Becker's to discuss the payer behavior challenging his physician-owned surgical hospital.
Question: What payer behavior are you the most concerned with right now?
Chris Roy: Prior authorization processes produce a huge amount of administrative burden on our business office — all for a coveted authorization number that comes complete with a disclaimer that it is not a guarantee of payment. This increased workload to ensure we can get paid for services rendered while continuing to receive cuts to reimbursement pose a great risk to smaller practices, physician-owned and rural hospitals, and ASCs. I am concerned with some payers moving to a "meets policy" requirement instead of an authorization process that the risk we must accept toward getting paid or denied for procedures performed will become even greater. After all, with prior authorization, at least we received an authorization number.