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Effectively Dealing With Preauthorization in Medical Billing

Dealing with prior authorization is an essential part of medical billing process. Preauthorization or prior authorization, as it is also known as, is the process through which insurance payer’s agreement is obtained for covering particular health care services before providing them.

Role of Prior Authorization in Medical Billing

Patients’ insurance plans are required to be confirmed for covering certain services and procedures before being provided by the caregivers. Normally, upon being checked for eligibility, payers who are responsible for authorizing a treatment or service before an encounter have to assign the authorization number which the health care providers are needed to include in their claims while submitting them for payment.

Getting the Right CPT Code Upfront

Providing correct CPT code is key in preauthorization. It is challenging to provide appropriate procedural code even before a service is provided. It is a difficult task that calls for checking with treating physicians and finding out what they anticipate in near future. It is essential to get all probable scenarios in order to avoid the risk of providing a service that is not covered.

Managing the Preauthorization Burden

Preauthorization is an integral part of health care organizations. By following certain strategies, practices will be able to reduce the financial burdens and the time taken for these activities. Checking the frequency of the payers requiring prior authorizations and balancing that with their reimbursement level is good for understanding the preauthorization requirement.

Practices having several locations can improve efficiency by centralizing their preauthorization responsibility. Having the forms needed for procedures and drugs commonly require preauthorization easily available will be helpful.

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