Prior authorization helps the practice to avoid denials from the insurance on high dollar value procedures. The absence of pre-authorization in medical billing most likely results in non-payments of the claims. We help you to take over the burden of pre-authorizations by submitting the necessary records and obtaining the pre-authorization 2 days in advance.
Our robust and transparent system helps the practice monitor the status of all pre-authorizations we have initiated daily. As your trusted partner, our team of experts works with all government and private insurance companies, such as Cigna, Humana, Medicare Advantage Plans, Medicaid, and all commercial insurance companies, based on the practice protocols.
Authorization in medical billing refers to the process wherein the payer authorizes to cover the prescribed services before the services are rendered. This is also termed authorization or prior authorization services.
We verify what services require prior authorization during the insurance eligibility verification process. The approval is based on the patient’s insurance scheme. Insurance companies authorize the request based on the benefit terms required for medical procedures. The insurance provider gives an authorization number, which has to be quoted in the final claim form, which will be submitted after the treatment is completed.
Our experts initiate the authorization differently based on calling and uploading the documentation in the insurance portals. This helps the practice pre-authorize all the procedures promptly, thus improving the practice’s cash flow. If the authorization requires peer-to-peer review, we alert the practices ahead of the patient’s scheduled procedure. This helps in avoiding the denial of authorizations.
Billing team at Premium Medical Billing Solutions is well-equipped and uses online insurance portals to get all the material to apply for authorizations. Our experience coordinating with insurance companies gets the job done faster and more efficiently.
If you choose not to outsource prior authorization services from us and handle them in-house, several challenges and consequences may arise:
Increased Administrative Burden:
Prior authorization requires meticulous documentation and communication with payers, which can significantly increase your staff’s administrative workload.
Time-Consuming Process:
Managing prior authorizations internally can be time-consuming, leading to delays in patient care and potential revenue loss.
Lack of Expertise:
Without specialized knowledge of payer requirements and prior authorization processes, your staff may struggle to navigate the complexities effectively, leading to errors and denials.
Reduced Focus on Patient Care:
Spending time on prior authorizations detracts from your staff’s ability to focus on providing quality patient care and attending to other critical tasks within the practice.
Potential Revenue Loss:
Mishandled prior authorizations can result in claim denials, delayed reimbursements, and ultimately, revenue loss for your practice.
Compliance Risks:
Adhering to payer guidelines and regulatory requirements in the prior authorization process can lead to compliance issues and potential penalties.
Staff Burnout:
The added administrative burden and stress of managing prior authorizations internally can contribute to staff burnout and decreased morale.
Inefficiencies and Bottlenecks:
Without streamlined processes and dedicated resources for prior authorization, bottlenecks and inefficiencies may occur, hindering practice operations.
It can take a few days to several weeks to receive a decision from the insurance companies.
Common examples include expensive medications, certain medical procedures, specialized tests, durable medical equipment (DME), and treatments that are considered non-standard or elective.
Our prior authorization services streamline the process by handling all administrative tasks related to prior authorizations, including paperwork, follow-ups, and appeals.
Prior Authorization is to verify and obtain advance approval from the payer if a patient requires a specific service before it is performed.
Yes, our services adhere to all HIPAA regulations to ensure patients' protected health information (PHI) privacy and security.
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