Why Prior Authorizations are Never in Your Favor:
Do You Know How to Win The Game?
"I am finding myself always on the phone, always arguing for a medical procedure best for the patient!" "I find my patients waiting, while I explain why a particular PET or a CT scan must be preauthorized! " Can anything be more frustrating for a medical practice?
- The Kaiser Family Foundation estimated almost an expenditure of 868.4 million hours on obtaining prior authorization from the insurance companies. Prior authorization remains the largest source of denied payments and write-offs!
- Value-based care; the objective is to deliver proactive care as and when needed. With over $ 31 billion being spent on an annual basis on just prior authorization, healthcare providers have to leverage the best use of technology that accelerates the process of practice management.
- Although the electronic standard for prior authorization is there for over a decade, complexities especially at the local level, is hampering meaningful adoption!
Seamless exchange of data between the provider and the payer is still hindered with clunky payer web portals that map with their individual workflow patterns. Healthcare at large is still fundamentally local! Whether it is the EMR on the provider side, utilization management systems with the payers end are old and are often not able to keep pace with the changing business dimensions.
Even if the two systems are able to communicate, reconcile and absorption of data is not effective enough, making integration quite gloomy!
The entire authorization process is the most important aspects to effective revenue cycle. The patient access departments still do not have the right resources to combat the demand for authorization requests!
Do you know? Sun Knowledge is currently processing more than 50,000 prior authorization requests on a daily basis!
The Medicare and Medicaid cuts are only going to be another challenge and a more streamlined practice management/ revenue cycle management effort will set the benchmark!
Appealing to all of the “no auth denials” that you are facing as an organization will require you to have a combination of manual and electronic process with a bunch of resources that understand modern practice management demands!
Sun Knowledge: Sets the difference with a complete action plan!
Sun Knowledge is a next-gen healthcare medical billing company, specialized to provide end to end practice management/ revenue cycle management assistance. Our stand-alone services for all specialties include:
- Eligibility and authorization verification
- Prior authorization services
- Coding
- Claims submission
- Accounts receivable management
- Denial management
- Contact Center services
Let's start, leverage the best out of our proprietary platform "Prior Auth Online", get the best out from us with our functional support with your practice management needs. Our eligibility verification services start from $0.85 per claim!
At just $7 per hour, Sun Knowledge will provide you complete support and a robust action plan for your prior authorization demands! We do:
- Gather vital information on medical procedure, patient, and provider
- Verify and validate prior auth request with effective payer side communication
- Check the patient’s eligibility
- Initiate the auth request based on the payer mandates
- Checking the auth status
- Collating relevant documents from the ordering physicians/follow up
- Providing additional information if any
- Update the auth income in the PM/Billing system
Our experts are ready to give you a demonstration. Let us share our references, get to know our best practices. Partner and better your financial ROI with the Sun Knowledge advantage!