All You Need To Be Aware Of Prior Authorizations

1
All You Need To Be Aware Of Prior Authorizations
Prior authorization is an essential element of
medical billing and coding, particularly when
claims are to be settled by an insurance company.
It is the process of obtaining insurance carrier
approval to treat specific services. Getting
approval from the payer ahead of time increases
the likelihood of a smooth claims settlement. The
procedure involves obtaining an authorization
number, which providers must include on the claim
during submission. While it may appear simple,
the process of prior authorization is fraught
with complications. Providers must be aware of
pre-authorization guidelines and payer coverage
and provide the specific diagnosis on reports.
Lets see what all you need to know about the
prior authorizations Read more..
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
2
All You Need To Be Aware Of Prior Authorizations
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
3
All You Need To Be Aware Of Prior Authorizations
Problems with Prior Authorization Even though
insurers approve most requests, the process can
be time-consuming and involves the administrative
hassle of endless paperwork, repeated phone
calls, and mounting claim piles. This can disrupt
or delay a patient's access to vital care.
According to a recent American Medical
Association report, 64 of providers reported
waiting for at least one business day, and 30
reported waiting at least three business days.
According to the same report, approximately 84
reported that prior authorizations result in high
or extremely high administrative costs, and 85
agreed that provider issues with prior
authorizations have increased in the last five
years. Approximately 60 of doctors received a
response at least within one business day.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
4
All You Need To Be Aware Of Prior Authorizations
The Influence of the Pandemic on the Prior
Authorization Process According to a recent poll
conducted by the Medical Group Management
Association, 81 of various medical groups have
confirmed a significant increase in the
regulatory burden of prior authorization
requirements since 2020. Healthcare providers
have complained about a lack of staff to deal
with the influx of COVID-19 patients. In response
to the pandemic, states in the United States
asked insurers to temporarily waive the PA
requirements. However, every insurer provider has
its own set of PA requirements, and many of them
were hesitant to accept the waiving appeal.
Furthermore, different states in the United
States are taking their own distinct approach to
a temporary policy change for PA requirements.
This adds to the uncertainty about policy changes
being implemented across the country.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
5
All You Need To Be Aware Of Prior Authorizations

• First Task Ensure Correct CPT Code
• Capturing and providing the correct CPT code is
  required for robust pre-authorization. However,
  the exact procedural code must be identified and
  documented before administering the service to
  the patient. Although this is required for clean
  claims, it is a difficult task. The best way to
  ensure that the code is correct is to contact the
  physician and learn how they intend to carry out
  the treatment.
• Approximately 85 of physicians believe the
  burden of Prior Authorization is high or
  extremely high.
• Prior Authorization Best Practices
• Keep Necessary Information Ready
• Comply with All-Payer Criteria
• Obtain Preauthorization for Routine Procedures
• Conduct Regular Audits

HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
6
Why Is It Better to Outsource Prior
Authorization?
The fact that standardizing best practices for
prior authorization could take years, and as it
involves multiple, complex steps, advanced
technologies such as in-house automation may not
be able to optimize workflow efficiencies as
effectively. Previously, outsourcing was
primarily used as a cost-cutting strategy.
However, operational efficiencies and sustained
growth have replaced the benefit of lower costs
over the year. Modern outsourcing medical
billing and coding partners such as 24/7 Medical
Billing Services ensure this through strategic
thinking and innovations to complex processes.
This further allows the providers to focus on
their core services and compete more effectively
in a rapidly changing market.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
7
About Us
We are a medical billing company that offers
24/7 Medical Billing Services and support
physicians, hospitals, medical institutions and
group practices with our end to end medical
billing solutions. We help you earn more revenue
with our quick and affordable services. Our
customized Revenue Cycle Management (RCM)
solutions allow physicians to attract additional
revenue and reduce administrative burden or
losses.
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/
8
Contact Us
Media Contact 24/7 Medical Billing
Services Georgia 3001 Greenfield Drive, Marietta
GA Ohio 28405 Osborn Road, Cleveland, OH
4414030068 Texas 2028 E Ben White Blvd,
240-1030 Austin TX, 78741 Delaware 16192
Coastal Highway, Lewes, Delaware 19958, United
States Phone no / Fax [phone]
Email us info_at_247medicalbillin
gservices.com
HTTPS//WWW.247MEDICALBILLINGSERVICES.COM/