Insurance Prior-Authorizations

Posted by mgsionline on May 20th, 2013

Several factors influence insurance payments, of which prior-authorization seems to be one important factor that is often overlooked by Providers. What is Insurance Prior-Authorization? It is the process of obtaining an approval to cover specialty services, Durable Medical Equipment (DME) and specific medical supplies. All Providers are required to get this approval prior to providing specialty services to patients for better medical practice management. Getting prior-authorizations from insurance companies has several advantages, which are briefed below,

Accurate Physician Billing: It is the first main advantage of getting prior-authorizations from insurance companies. When the specialty services are pre-authorized, then the provider’s billing happens without a hitch and payments are received on time. If Providers feel that they cannot administer the work involved in obtaining prior-authorizations, they can very well outsource it to a medical billing company.  This way, they can save time and focus on the primary patient care services.

Denials: Some Healthcare Providers obtain prior-authorizations for non-specialty services as well. Many consider it a mere ‘waste of time’, but, in reality it is an excellent practice that every Provider must follow. The reason is prior-authorizations can be used as a proof at a later date, when claims get denied by payers.  The prior-authorization number can also be used to contest a Denial since the Payer had already authorized the service.

Cost Analytics: The common perception among most Providers is that obtaining prior authorizations in-house is a time and money-consuming task. However, the simple fact is that the cost involved in obtaining prior authorization using internal resources is actually lesser than the costs involved in working the denied claims multiple times, which are unauthorized. Therefore, Providers must take prior-authorizations seriously to promote good medical practice management.

Outsource: Yet another best way for Providers to save time and money is outsourcing a part of Provider Billing. A medical billing service communicates a Provider’s prior authorization requirement to health insurance carriers and gets the approval on time with the Authorization number. If you are looking for such a company, try MGSI!  

About MGSI:

MGSI is a Florida based medical billing company, which has over 20 years of experience in providing exceptional physician billing services. In addition to full Medical Billing and Collections, MGSI also provides Insurance prior-authorization and other support services. For more details, log on to www.mgsionline.com