IMPROVING THE EFFICIENCY OF BILLING COMPANIES THROUGH PRIOR AUTHORIZATION

Prior authorization is an essential component of Revenue Cycle Management. This indicates the approval for the physician to start the medical procedure. Authorization refers to the permission of the insurance provider of the patient. It is essential for the insurance company to be aware of the medicines, and procedures that the patient will be undergoing.  In certain cases additionally, an explanation from the physician why a particular medical procedure or drug is essential for the treatment process. Therefore, it is vital for the practitioner to have permission before starting the procedure. This will ensure a smooth flow of the claim settlement as well as high-quality care. Nowadays, healthcare billing companies in USA are currently providing prior authorization as part of the RCM package. This ensures the smooth functioning of the institute as well as an increase in overall revenue generation. 

NEED FOR PRIOR AUTHORIZATION

The process of prior authorization is necessary for a number of reasons. The biggest of them is for the insurance companies to control expenditure on a particular patient. This process ensures that the prescription and the medicines are only for the insured person, and not for any other person. 

The process of obtaining prior authorization may take up to 3 days. Therefore it is essential for healthcare institutes to obtain the authorization process beforehand. This helps in lowering the settlement time significantly. 

A well-planned strategy for the billing process includes - 

• Beginning the prior authorization process early. 

• Following the timeline for ensuring the timely submission of patient information and details.

• Following up, in case of no replies from the company even after more than 5 days of sending the request. 

• Providing complete transparency to the patient so as to speed up the process. 

IMPROVING PRIOR AUTHORIZATION

The authorization process has plenty of potential for improvement. The improvements in the process can be in the form of - 

Electronic system - 

Most healthcare institutes still use the old manual method. This not only consumes a lot of time but also leads to a lot of errors in the process. It is essential for healthcare institutes to upgrade to the latest available technologies. This improves the overall functioning of the institute. 

The electronic system is further connected with the EHRs. This removes the need for paperwork and manual documentation and minimizes errors as well as delays. 

Understanding the policies -

The practitioner needs to understand the authorization criteria for each patient before proceeding with the treatment or even submission. Following the authorization policy properly ensures there are minimal chances for delays as well as for denials. 

Obtaining timely authorizations ensure a smooth flow of the procedure. Therefore healthcare institutes hire specialists who help in obtaining this authorization as soon as possible. 

Creating a protocol -

Protocol refers to the process of following a set of established guidelines. This ensures the proper collection of patient data at the time of admission. Precise and complete details of patients mean timely approvals and smooth functioning. 

Using a centralized system -

Centralizing the process for obtaining authorization results in a direct improvement in efficiency. This also helps in solving a lot of inconsistencies and provides a reliable approach. 

Following-up -

This is the most essential step. Timely authorization requires regular following up. There are multiple cases when there are delays due to the companies just randomly forgetting the file. Therefore, in order to get timely authorization, regular following up is essential. 

WAY AHEAD

The process of obtaining prior authorization is modifying the way healthcare institute function. This is because of quick settlements and minimal denials. Outsourcing the process also helps in developing a better relationship with the insurer. This is mainly because prior authorization is a very efficient approach. 

Institutes that are planning to outsource RCM are looking for healthcare billing companies in USA that provide all such activities as a package. Therefore more and more companies are coming up with packages that fulfill all such requirements.