Dealing with Pre-Authorization in Medical Industry

Pre-Authorization in Medical Industry
Pre-Authorization in Medical Industry

Among the many frustrating and time-consuming processes, physicians are required to complete as part of their job is to deal with the pre-authorization. Getting pre-authorization for procedures to be performed is expensive in terms of time and productivity as it takes a considerable amount of time in getting it from the payers. Receiving pre-authorization for procedures consumes a lot of time of the revenue cycle management department and affects the productivity of the physicians as they have to wait until they get the authorization to go ahead with certain procedures. This may also affect the health of the patient adversely in some cases.

What is pre-authorization?

A pre-authorization is the decision by a health insurer approving that a healthcare service, treatment procedure, prescription medicines or medical equipment for a procedure are medically necessary that would be billed by the medical billing professionals in the future. Pre-authorization is necessary to check if the procedure that is being asked for is really that necessary for the patient and if the patient is healthy enough to receive such medication or procedure.  This plays a significant role in the revenue cycle management process because some legal requirements demand that healthcare providers take approval from health insurance providers before providing certain services or performing specific procedures. This, though aimed at minimizing care costs, may turn out to be a barrier to providing the highest quality care at the fastest pace possible which is the key to improve a patient’s health and satisfaction.

Why is it terrifying for physicians?

The prior-authorization process begins with the physicians well before the processes of RCM services. It is an arduous task that consumes away a considerable amount of physicians’ productive time that can be very well used for a better quality of service to the patients.

How it can be effectively managed?

RCM services providers tell that though it is a time-consuming process, it is vital to avoid any kind of legal or financial problems in the later stages. According to the top revenue cycle management companies, the best way to curtail the costs and difficulties in the pre-authorization process is to identify the documentation and information requirements of the insurer companies in the beginning stages itself and following the processes accordingly.

Hiring the best RCM services providers to tackle all the revenue cycle processes from prior –authorization, to billing, to submitting claims, and receiving reimbursements is the one-in-all solution for timely claim submittals, reduced denials and in-time reimbursements for the services provided.

Dealing with Pre-Authorization in Medical Industry
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