PAYOR ACCOUNTABILITY

Fair and transparent payment policies are essential to ensuring hospitals can continue providing high-quality care to Floridians. FHA advocates for equitable reimbursement models and opposes harmful, unilateral payer policies that create unnecessary barriers to care. FHA also supports reforms to streamline prior authorization, reduce payment delays, and prevent burdensome practices that strain the health care system.

SESSION PRIORITES: ENSURING FAIR PAYOR PRACTICES AND TRANSPARENCY

FHA advocates for policies that ensure fair and timely reimbursement, reduce administrative barriers to care, and improve oversight of managed care plans. Strengthening transparency and streamlining approval processes are essential to maintaining access to high-quality health care for all Floridians.

Holding Payors Accountable

Hospitals face delayed payments and denials from insurers, often due to unclear documentation requirements and inefficient prior authorization processes, which delay care and burden providers.

Prior Authorization

Prior authorization delays critical care, with insurance reviews taking days or weeks, potentially jeopardizing patient safety. FHA supports reforms for faster responses and reduced restrictions.

Centralized Credentialing

Florida Medicaid providers face redundant credentialing across managed care plans. FHA supports a centralized system to streamline approvals and speed enrollment.

Managed Care Plan Transparency

Florida needs greater oversight of AHCA’s $36 billion managed care contracts to ensure timely, transparent reporting on plan performance.

Fair Health Insurance Practices

Prior authorization delays care, interferes with clinical decisions, and creates administrative barriers. Reforms are needed to ensure timely access and fair practices.

ADDITIONAL COLLATERAL

Hospitals work to ensure patients receive timely care, but delayed payments, denials, and administrative hurdles from insurers create financial and operational challenges.

Patient Discharge Delays

Waiting for placement substantially increases hospital costs. The data shows avoidable costs incurred by the hospitals with patients awaiting placement. Timely discharges from the hospital allow beds to be available for patients who need hospital care, especially when patients often wait in the emergency department for inpatient beds.