Insurance Authorizations
Medical Necessity
Prior authorization ensures that a patient’s insurance plan covers the proposed medical services before a physician performs them. This step prevents denied claims, reduces payment delays, and improves overall financial stability for doctors. It also helps them focus on patient care and avoid unwarranted costs. Our medical billing services can facilitate this process by ensuring that patient registration details and CPT codes are correct.
Some healthcare services may require prior authorization from the payers, which can be a long-winded process. Several healthcare practices have experienced denials due to errors in this process. Hence, it is important to keep up with the process regularly to reduce the number of denials. In addition, doctors should communicate with patients about their financial responsibilities and deductibles to boost transparency and compliance. They should also be able to handle patient statement processing, which involves providing patients with a detailed breakdown of the services rendered and their associated costs. The statement should be easy to read and timely delivered to promote financial engagement.
All of this, is a time taking process. But you don’t have to do it yourself when we’re ready to help you.
Benefits of Our Insurance Authorization Process
Eligibility
In Revenue Cycle Management (RCM), prior authorization, also called pre-certification, is a requirement for medical procedures and pharmaceuticals to be covered by insurance. It confirms that a particular treatment or medication is medically necessary. Prior authorization is a crucial part of the RCM process because it reduces the risk of claim denials and increases patient satisfaction.
But, different insurance companies and doctors have different rules that keep changing, which makes it hard for doctors to keep up. Medical billing staff need to know all the details about these rules, including how to code and get paid for treatments. This is tough for busy doctors who want to focus on their patients.
A specialized RCM partner like Whitebird can handle these tricky requirements, letting doctors spend more time with patients. We help collect payments better, increase the money coming in, and reduce payment problems.
