Outsourcing your prior authorizations process can help you reduce denials, save time and money, minimize data errors, and improve patient care.
Pre-authorizations (PAs) are a very labor-intensive task for healthcare providers, their staff and patients. Prior authorization is a process by which healthcare providers must qualify for possible payment coverage. This is done by obtaining advanced approval from a health plan before a specific service is delivered to a patient.
According to the American Medical Association (AMA), prior authorization is overused and existing processes present significant administrative and clinical concerns.
Outsourcing your prior authorizations process can help your practice to focus on patient care. It will also allow a trusted partner to manage the process with high quality standards while relieving your staff from the administrative burden.
Here are some reasons why you should consider outsourcing your pre-authorizations process:
- Reduce denials: There are a wide variety of reasons for prior authorization denials such as errors, coverage issues, or failure to follow the steps required by the health plan. Reduce denials by ensuring all patients coming for network or out of network visits, advanced diagnostic, or elective procedures have proper pre-authorizations on file.
- Save time and money: According to an AMA survey data, physicians and their staff spend an average of almost two business days (13 hours) each week completing prior authorizations. In this same survey, 88% of physicians describe the burden associated with PA’s as high or extremely high. Free up time for your staff and save costs for your medical practice by outsourcing this process.
- Minimize data errors: A trustworthy outsourcing partner will be on top of guidelines and industry changes. This will help you ensure this process is being completed correctly and in compliance with insurance providers. They can also help you collect patient information from your providers clinical documentation to obtain prior authorization for inpatient and outpatient procedures, and/or office visits requiring this.
- Improve patient care: Based on a recent AMA survey taken by practicing physicians, the data indicated that prior authorization continues to interfere with patient care and can lead to adverse clinical consequences. Based on that study, 34% of physicians report that PAs, or the lack of them, have led to a serious adverse event for a patient in their care. Reduce your staff´s burden from doing prior authorizations so they can focus on what matters the most: your patients!
Let us know how we can help!
Health Prime offers Prime Authorization, our optimized Virtual Office solution that helps with prior authorization or pre-certification of services you are rendering, depending on your medical practice needs. We can do the work to obtain the precertification/prior authorization of services for a patient. If we have all proper documentation from the practice and provider, we can process it.
Proper documentation for this process consists of a completed and signed medical record with:
- the test or procedure order listed along with the body part.
- CPT code or specific procedure ordered.
- the ICD10 code.
- any previous treatments or medications tried.
Outsourcing your prior authorizations process helps medical practices focus on patient care and allows us to gather, filter, report, and manage your process with an unbiased approach. We also stay updated on changing government regulations, so your practice doesn´t have to worry about authorization compliance issues.
If you want to know more about outsourcing your authorizations processes, feel free to reach out to us at [email protected] to set up a meeting with us. Let´s discuss how we can help you get back to what matters the most: your patients.
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