Insurance Policies go through a cycle of regular changes affecting Medical Billing and Claims Processing. To add fuel to the fire, procedures requiring Prior Authorization are often updated and changed and the requirements vary with each payor; making it even more difficult and complicated for the Physicians, Billers, and Coders to ascertain the particular medical procedure requires Prior Authorization and make efforts to have it on time to avoid claim denials and revenue loss. Minimizing Claim Denials is a primary requirement for any practice, with that being the case, having a strategical approach towards prior authorization can help reduce related denials.
Let us look into how Prior Authorization has been affecting Medical Practices and their revenue with step by step strategical approach to fix these challenges.
Know about Prior Authorization
Prior Authorization also called as Pre-Authorization is the process of obtaining approval in advance from the Insurance Company or healthcare plan for certain medical procedures before treating the patient.
Missing to apply for prior authorization on time can delay timely patient care, lead to claim denial and result in revenue loss.
Challenges in Prior Authorization
- Delays patient care affecting quality services and practice reputation
- Time-consuming for the Physician and Medical Billing team
- Expensive and laborious compared to other billing process
- Policies and procedures requiring Prior Authorization differ from payor to payor
- Failure to get Prior Authorization on time can affect practice revenue
- Ineffective Prior Authorization can lead to an increased denials ratio.
Strategies to Minimize Authorization Denials
- AI-Driven Software: Leveraging Technological intelligence can bring down human efforts and help increase quality and reduce denial percentage. Upgraded tools help streamline Prior Authorization, Insurance Eligibility Verification and benefit checks.
- Insurance Eligibility Verification: Insurance Eligibility and Benefit Verification play an important role in minimizing authorization-related denials and keep denial percentages raising above accepted quality standards and affecting the bottom line of the practice.
- Keep up with Payor Specifications: Most times, denials are results of billing team missing on the health plan policy specifications. With each payor having varying policies and coverage benefits, it is apparent for billing and coding team to make oblivious errors
- Check Prior Authorization in Advance: Always raise authorization request for medical services before providing the treatment. Following this step will eradicate most possible authorization denials and prevent delays in patient care.
- Streamlined and Strategical Approach: While the entire Medical billing and RCM process is complex and exhaustive which requires meticulous attention, having a streamlined and strategical approach can help even the experienced team to ensure they do not miss on any crucial process. A systematic method leads to sophisticated progressive results avoiding possibilities for any loopholes.
About MGSI
MGSI is a leading Medical Billing Company in Tampa, FL that provides complete Revenue Cycle Management Services to its 600+ Physicians across the U.S. With over 27 years of Medical Billing expertise. MGSI is an A+ rated Medical Billing Company from the Better Business Bureau and compliant with HIPAA Standards to protect PHI. With our team of experts handling Prior Authorization and Insurance Eligibility Verification, MGSI guarantees maximum reimbursement with lowered possibilities of claim denials or low payments. To know more about MGSI call us at 1-877-896-6474 or log on to Insurance Eligibility Verification – Healthcare Services | MGSI (mgsionline.com)