Today, the biggest challenge faced by healthcare providers is to survive the dropping profits and increasing costs. In recent times, the profit margins for healthcare providers have gone down significantly due to changes in federal laws and increased competition. Increasing labor and medical equipment costs have only added to the misery. The only way out for the healthcare service providers is to get their reimbursements in full and on time.
This necessitates the requirement of a streamlined and capable claim submission process. Every time a claim is denied, it takes three times more effort, money, and time to resubmit the claim. Inability to acquire pre-approval before rendering services is one of the major reasons for claim denials. An insurance provider will not release reimbursements for the procedures which require prior approvals but were rendered without them.
Radiology service providers are the frontline fighters of claim denials as most of the imaging procedures require prior authorization. Procedures like MRI, CT, and PET imaging cost very high and if the provider does not have proper authorization, these claims will be denied reimbursements. This is the reason why the Radiology Billing department must have a redundant prior authorization procedure.
Let us explore some of the steps that can help streamline the Radiology Prior Authorization procedure:
Collect complete patient data and keep it updated
This task involves both the front desk and the back-end billing team. The billing staff needs to identify the data required for filing a successful prior authorization request. This data requirement then needs to be shared with the front desk staff so that they know what information needs to be gathered. It is always good to provide your front desk staff with a list of requirements so that they do not miss out on any data. The staff needs to indulge with the patient and collect every demographic detail required. Also, once the data is collected, it needs to be validated every time the patient visits the facility. Any change in the coverage status or demography needs to be properly updated.
Regularly Co-ordinate and Change Authorizations if Required
The internal teams of the Radiology service provider must coordinate seamlessly to ensure every concerned person is aware of the prior authorization status. Any change or delay in receiving approval needs to be highlighted.
The imaging service schedule needs to be changed in case of a delay in receiving authorization. Similarly, the insurance company needs to be updated about any change in the procedure for which the approval was received. Such changes or updates need to be communicated seamlessly to avoid claim denials.
Monitor Denials
Make it a habit to go through denied claims. A careful inspection of the denied claims will help you in identifying patterns. These patterns will help you identify and address all the loopholes in the processes your staff follows. It is suggested to create a process manual and circulate it within the concerned staff to enable them to refrain from committing errors.
Devise Payer Based Action Plan
This is required especially when you work with multiple payers. Every payer has its own set of requirements. The data suitable for one payer may fall short for another and lead to claim denial. Your medical billers and prior authorization experts must have a complete list of requirements of different payers you are engaged with. This will help them file payer-specific details in their prior authorization requests for faster approvals.
Taking care of all of the aforementioned tasks for streamlining your claim processing system will require a lot of time, money, and dedication. Regular software updates, staff training, infrastructure development, hiring professional billers & coders, and other expenses will become an integral component of your organization. Implementing precautionary processes and monitoring their impact will consume a lot of time of the top management staff. This will eventually shift the focus from the most important duty of your staff which is patient care and patient satisfaction.
How Outsourcing Radiology Prior Authorization to Sunknowledge Will Help
Sunknowledge has been helping top healthcare providers for the last 16 years. We are a strong team of 4,500+ experienced billers and certified coders. With our unique experience of working with both, payer and provider, we know what it takes to ensure a streamlined prior authorization system.
Our experts have proficiency across all practice management systems and deliver customized support based on the client’s mandate. Being an end-to-end medical billing and collections company, we offer dependable support and unmatched efficiency. Our tireless support and industry-leading productivity have earned us laurels and recommendations from our clients.
Do contact us for immediate support in the radiology prior authorization process. We have all the resources and technology you require for streamlining your revenue flow. With prices as low as $7 per hour per resource, we not only offer unparalleled support but also significant savings on your hard-earned money.
