Prior- Authorization
What is Authorization in Medical Billing?
There are certain procedures that mandate pre-authorization from the insurance provider. During the insurance eligibility verification process, we must ensure to verify on what services require prior authorization. The approval is based on the insurance scheme of the patient. Basis the benefit terms, required medical procedures, insurance companies pre-authorize the request. A pre-authorization number is given by the insurance provider which has to be quoted in the final claim form which will be submitted post the treatment is completed.
A pre-authorization number is given by the insurance provider which has to be quoted in the final claim form which will be submitted post the treatment is completed.
Why Is Pre-authorization Services Important In RCM?
Pre authorization in medical billing helps in hassle free claim of bills. Authorization does not guarantee payment of bills. However, not having a pre-approval can result in non-payment or denial of the bills.
Challenges In Pre-Authorization
Right diagnosis and providing the correct medical codes are very crucial in pre-authorization. Correct coding and documenting the required procedure before the treatment is the key for timely pre-authorization. This is often a challenging task. A coder’s role and task make a huge impact in this process.
To Avoid Prior Authorization denials, we follow this steps :
- A thorough verification process to know the services covered to obtain pre-authorization
- Maintaining complete documentation and record of all necessary information
- Understanding the contract terms and process of various insurance providers
- Adhering to their guidelines to avoid delays and denials
- Having standard templates to avoid documentation and human errors
- Providing necessary training to staffs for all necessary procedures
