Ensuring Efficiency in the Insurance Authorization Process

by | Published on Sep 4, 2012 | Insurance Verification and Authorizations

Share this:

Getting insurance authorization is crucial to the success of any practice. Health insurance companies have stringent rules when it comes to making payment. While they pay for medically necessary services under a member’s health plan, insurers impose barriers when it comes to certain tests and procedures. Therefore healthcare practices need to obtain insurance authorization to ensure that the services they provide each patient are covered. Failing to do so would result in non-payment and loss of revenue, and ultimately affect patient care.

The specialist who performs a particular procedure is responsible for obtaining authorization for that procedure. This makes sense as the specialist has all the information about the patient’s medical history and demographic details that the insurance company requires to make their decision. A Request for Authorization form has to be completed and submitted online. Approved requests are then confirmed in writing and delivered either by mail or fax.

Simple as it may sound, the procedure of obtaining insurance authorization is usually never so smooth. Each insurance company has its own set of rules and physicians and their staff members are expected to know these rules. In many cases, authorization forms are submitted, denied, resubmitted, put on hold – the process is becomes tedious and endless.

Luckily, all these issues can be avoided by outsourcing insurance authorization to an efficient service provider. A professional team takes care of all the authorization procedures, relieving the physician and his staff of their burdens. Services offered would cover

  • Verification of patient details with the insurance company, online and through phone calls
  • Checking of all insurance benefits and demographic details
  • Ensuring completeness and validity of information supplied
  • Timely and continual communication with the insurer to obtain authorization

Practices, both big and small, would benefit greatly by outsourcing to the right service provider. This can ensure quicker approval and authorization to reduce risk, avoid unnecessary expenses in the form of time and money, speed up billing cycles, increase revenue and improve patient care.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

More from This Author