By NextBestFitHealth administration and software vendors
Businesses supply billing, coding, eligibility, utilization management, and health record systems.
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Problems that hurt them
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Problems they gain from
Paths that fix these cost them.
- Patients can't know prices in advance: They profit from pricing complexity.
- Prior authorization delays and blocks care: They supply utilization-management services for approval requirements.
- Medicare Advantage overpayments and coding intensity: They provide risk-adjustment and coding services rewarded by larger payments.
- Clinician burnout from paperwork and EHR work: They supply the record and billing systems used for administrative work.
- Records don't follow patients: Record-system lock-in benefits vendors.
- Copays keep billing systems alive and still deter poorer patients: Copays preserve demand for billing services.