Federal auditors found that 13 percent of the prior authorization requests Medicare Advantage plans denied met Medicare coverage rules, care that likely should have been approved.
The pressure that creates lands on the revenue cycle.
This report shows how health systems are building revenue cycle models that account for this gap, catch reimbursement risk before billing and apply specialty expertise where financial exposure runs highest.
Inside the report:
- Where reimbursement risk concentrates across oncology, surgical, cardiology, behavioral health and imaging
- Why revenue cycle risk begins at the order, not the claim
- What to centralize and where specialty expertise matters most
- A phased path to identify risk, design specialty support and measure results