Provider & Payer Dynamics: Revenue Cycle’s Evolution

Pre-authorization is a word that is being tossed around more and more frequently in the healthcare world. Often referred to as pre-approvals, prior approvals, or prior authorizations, these are insurance-dictated restrictions on medicines, tests, or health services that require a check before insurance will officially cover the product or service. More than three quarters of medical practices believed that prior authorization requirements rose over the past year. This is just one of the changes in payer dynamics that has led to evolution in revenue cycle management.

How are payers and providers handling changes such as these that are impacting healthcare revenue cycle management and placing increased tension on payer-provider relationships and the fiscal responsibilities of healthcare entities?

On today’s episode of Highway to Health, Host David Kemp speaks with Christina Cussimanio, Senior Vice President Marketing at AGS Health, to talk about the current state of healthcare revenue cycle management and payer dynamics, where providers are putting their big bets and the future of revenue cycle management.

Kemp and Cussimanio also discussed…

1. Changes in healthcare revenue cycles over the last decade
2. Where providers are currently placing their attention with revenue cycle management and where AGS suggests providers shift their attention
3. How payer-provider dynamics have switched from a fee-for-service to a value-based care model and what providers need to decrease the strain

“There’s just so many more hurdles for providers than there were ten years ago. Payers have more rules on pre-authorization because they’re trying to keep premiums from dramatically increasing and this really significantly increased the administrative burden and denial volumes for organizations. And so, the front end of the revenue cycle is growing in importance and it also impacts that patient experience,” Cussimanio explained of some major shifts between payers and healthcare providers the last several years.

Christina Cussimanio is an experienced healthcare and internet marketing executive currently serving as Senior Vice President of Marketing at AGS Health. Previously, Cussimanio worked as VP of Marketing at Hayes, Senior Director of Marketing, Healthcare IT at Quest Diagnostics, Director – Channel Marketing at Dealer.com, and Director of Marketing at General Electric. Cussimanio graduated with a BSc in Business with a concentration in Marketing from Northeastern University.