The Importance of Prior Authorization in Increasing Claim Reimbursement

Prior Authorization in Increasing Claim ReimbursementHealthcare industry is demystifying with time as new regulations are constantly looking to make inroads with newer innovations in medical science. It is important to note in this aspect that there are several loopholes in the practice management process of the providers that makes it a challenge to realize reimbursements in the right order.

♦ Pre-authorization is one of the cornerstones of ensuring the right checks & balances that will ensure proper synchronization in the claims submission process. Right from the verification to authorization, providers these days need to have best practices that helps them address prior authorization needs in correct order.

♦ One of the biggest challenges that are faced by clinical practices is the maintenance of a patient-centric model with comprehensive adherence to insurer guidelines.

♦ Providers spend countless hours & finances in pre-notification process precisely due to this reason as it guarantees them an understanding of the length of benefits that the patient enjoys.

♦ Alignment with the claims adjudication of the insurers is of prime significance that will allow seamless collection & accounts receivables. Prior Authorization services can well be acclaimed as the cornerstone of the entire backend claims & billing function.

Hence, it is critical to have a streamlined balance that allows flexibility in day to day operational practices. Some of the key attributes that needs to be looked upon during pre-certification as well prior authorization will be

HIPAA Compliance: One of the key aspects of the stringent ruling is the management of sensitive information of patients in a disciplined manner. Providers must have proper practices that will help them gain in on significance with their discipline in HIPAA adherence.

Understanding of insurer’s adjudication guidelines : During eligibility verification & authorization, it is indispensable to have a comprehensive understanding of the methodology of insurers that allows providers to follow head & keep the process as they would like it to be.

Following prescribed treatment : Every insurer has a specific set of provisions with medication & drug process that complies with a particular form of treatment. During your prescriptions, it is advisable that you follow a particular practice that will eliminate patient confusion & help them stay in concurrence with the original prescription.

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