Insurers don’t make obtaining preauthorizations easy, demanding substantial administrative time compiling patient histories, submitting claim forms, responding to information requests, and negotiating approvals. But skipping this burdensome process can lead to financial disaster.
Alarmingly, 70% of claim denials result from lack of proper preauthorizations coupled with failure to subsequently appeal. Without prior approval certifying medical necessity, payers reject related claims as out of policy. Appeals prove even less successful then, making preauthorizations imperative.
Savvy practices integrate preauthorization processes into workflows by designating skilled staff to handle requests. Attentive admins confirm eligibility, interpret benefits, assess medical policies, compile documentation per payer protocols, and persistently track status.
Successful preauthorization turnaround requires diligence and finesse. Staff must combat non-responsive case managers, obtuse bureaucratic demands, and abrupt communication gaps over weeks-long review periods. Meanwhile, patients await urgently needed care.
Still, obtaining advance approvals prevents otherwise avoidable losses that negatively impact finances and patient trust. Experts estimate preauthorization efforts realize over $100 in reimbursement per $1 spent – driving $1.7 million average returns for practices focused on doing them well.
Yes, burdensome administrative tasks divert valuable resources from direct care. But discontinuing them surrenders revenue, deteriorates panel confidence, and erodes community standing. By dedicating staff to understand opaque requirements and relentlessly shepherd submissions through convoluted processes, providers ensure payments due for excellent care rendered. The investment of time indubitably secures sustainability.
While preauthorizations consume resources, not obtaining them prior to rendering care can be financially catastrophic. Practices that excel in this arena will financially outperform practices who do not.
If you have questions or need help with improving your preauthorization process and subsequent collections, give us a call at (844) 424-5537 or send us a message here.
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