AI Prior Authorization Reveals a 90% Problem Hiding in Plain Sight

The vendor pitch sounds clean. The data tells a different story. If you run a practice, a health system, or a specialty group, you’ve probably heard the pitch. An AI vendor says it [...]

Prior authorization isn’t getting simpler. Despite years of reform promises, the 2024 AMA Annual Survey found that physicians now complete an average of 39 prior authorizations per week, [...]

When a claim comes back denied, the instinct is usually the same: send it to billing, figure out what went wrong, and resubmit. That workflow might feel like a system, but for many practices it [...]

I wrote this original post in 2024, and WOW, prior authorizations and their complexities have evolved. In 2025, over 50 major insurers voluntarily pledged to reduce prior authorization [...]

Most denials are not caused by incorrect coding. They are caused by missing or insufficient justification. Medical necessity is the standard that determines whether a service will be reimbursed. [...]

If it isn’t documented, it didn’t happen. And more importantly for your practice, it won’t be reimbursed. Medical documentation is not just a clinical record. It is the foundation of coding [...]

For small and mid-sized medical practices, clinical documentation is never just paperwork. It is the evidence that justifies care, the record that satisfies payers, and the foundation on which [...]

Administrative friction in healthcare rarely originates with a single dramatic failure. It builds quietly. A prior authorization gets delayed because the supporting imaging was not uploaded. A [...]

When a medical practice posts a job opening for a medical scribe, it usually signals one of two realities: providers are growing, or documentation is spilling into evenings and weekends. Right? [...]

Your time is your most valuable resource, and you must use it wisely. This is particularly true if you work in a hospital, in your own medical practice, or otherwise operate in a direct patient [...]