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While most people don’t usually plan on getting sick or hurt, everyone will need health care at some point or another. Medical insurance offers valuable financial protection against unforeseen events and can benefit both patients and healthcare providers. However, before a certain medical service can be covered by an insurance policy, it may need to go through a prior authorization process.

For many healthcare service providers, prior authorization can be a daunting task. In fact, medical prior authorization costs so much time and resources that it can offset some of the benefits of...

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The processes for prior authorizations continue to grow year after year. And with the need to decrease costs being greater than ever, many health plans are still continuing to increase the number of prior authorizations that are required for both medical and prescription benefits.

Prior authorizations are used by insurance companies to determine whether or not a policyholder is able to receive coverage for healthcare. This is often a complex process that involves several different parties including the patient, healthcare provider, insurance company, and the pharmacy (to learn more...

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When it comes to health insurance, it is important to keep in mind that some injuries and other healthcare services are not covered by health insurance. Keeping these in mind is a great way to prevent the nasty surprise of a big medical bill that you thought your health insurance was going to cover. Read on to learn what to watch out for, and if you run a medical facility and are looking for professional pre-authorization services, give us a call at AuthNet today for a free demo of our state-of-the-art solution.

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Healthcare facilities know all too well the struggle that comes with prior authorizations. Not only do they cost physicians practice time and money, but also have a detrimental effect on overall patient care.

Insurance companies may require precertification for outpatient and inpatient hospital services, observation services, physician-ordered medical tests, clinical procedures, invasive procedures, medication, medical devices, and more. This means that they will not pay for the service or medication until the physician has submitted elaborate paperwork that shows the necessity of...

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What if we told you that obtaining preauthorization no longer needs to be a time consuming and troublesome process? While many physicians are strongly pushing for complete elimination of preauthorizations, this scenario is unlikely. But fortunately there are a few steps that physicians can take in order to speed up this process and make prior authorizations much less costly and vexatious.

Step #1: Outsource Your Prior Authorizations

Taking into consideration how much time your staff likely spends completing prior authorizations, it doesn’t make sense to put...

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Although prior-authorizations are implemented to help with cost-containment, it is also very labor-intensive for health care providers, pharmacists, and patients. They require multiple telephone conversations and letters with supporting documentation, making it expensive and administratively unsustainable for many health care providers. With the number of insurance plans growing and there being more drugs than ever before requiring prior authorizations, it makes it more and more difficult for providers to keep up — and the failure to obtain proper prior authorizations can have a...

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Prior authorization, also referred to as preauthorization, is a practice that is used by health insurance companies that requires certain tests, procedures, and medication prescribed by healthcare clinicians to first be evaluated in order to assess the necessity and cost-of-care ramifications before they are authorized.

The prior authorization has many steps and is oftentimes very complex. In today’s post, we will be discussing the differences between the traditional, in-office prior authorization, and having prior authorization services outsourced with a reliable team of prior...

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With the world currently experiencing an unprecedented healthcare crisis, there is now a sense of chaos and panic that many people have never experienced before. With this widespread panic, healthcare providers are taking a lot of heat from patients who are seeking answers, asking questions, and so forth. Providers must do all that that they can to keep their patients informed, calm, and safe, and in today’s post, we will be providing tips on doing just that. This way, you will be able to connect and communicate well with your patients during this novel COVID-19 pandemic.

If your...

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In the face of the current COVID-19 pandemic that has swept the globe, hospitals everywhere are being tremendously impacted. The virus has led to healthcare system disruptions that are necessary for combatting the immediate threat of the virus, according to physicians. But, these disruptions are also forcing many patients who do not have the virus to take on a heavy burden. Individuals who are experiencing chronic conditions are needing to fight harder for the care they need — not only now, but also after the outbreaks come to an end. Hospitals will be left to deal with backlogs from...

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Source: CMS

CMS Adult Elective Surgery and Procedures Recommendations:

Limit all non-essential planned surgeries and procedures, including dental, until further notice

To aggressively address COVID-19, CMS recognizes that conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. Attached is guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. These...

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Put simply, a prior-authorization is a process used by certain health insurance companies to determine whether or not they will cover a prescribed medication or health services. This restriction is placed in order to help both your doctor and your insurance provider feel comfortable that your medications and/or services are medically appropriate for your care. At Authnet, we know that as a patient, the prior-authorization process can be frustrating. Here is a real-world example of the prior authorization process, what it entails, and how Authnet can help make this process go more smoothly...

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As a healthcare provider, you are no stranger to the amount of time that is consumed by pre-authorization tasks. It sucks up a lot of time, to be sure. But it’s more than just a minor annoyance. When you actually look at the numbers, it can feel downright criminal to realize how much time and how many resources are lost to pre-authorization.

You can expect to lose over 14 hours per provider each and every week from pre-authorization tasks. That’s more than 700 hours a year that you are spending on a bureaucratic task. If you have multiple providers, your office might be...

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It’s well-established that precertification causes an office to work less efficiently. We’ve discussed how it affects client experience, contributes to the stress of employees, and costs time and money — lots and lots of time and money. In fact, in a previous blog post, we discussed how you can expect an average annual cost of $28,000 per provider to do precertification in-house.

In today’s blog post, we want to take a look at the role that in-house precertification...

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AuthNet wants to keep our clients updated on everything that is going on in the world of prior authorization and precertification. As of June 5, 2019, there is talk of a bill on pre-authorization services going to Congress. The bill is expected to be introduced to Congress within the next couple of days. In our blog today, we will take a look at what this bill involves and why it matters to pre-authorization services.

What Is The Bill?

The name of the bill is the “Improving Seniors’ Timely Access to Care Act of 2019.” This bill is specifically addressing issues...

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The precertification process can be intensely stressful and time-consuming — not to mention expensive. As an example, for your typical primary care office, it’s estimated that the median amount spent on insurance prior-authorizations is more than $47,000 per full-time physician. When you’re dealing with these kinds of costs, it only makes sense to consider outsourcing. Something has to change, after all. It simply isn’t worth it to spend all that time and money on something that offers no benefit to the function of your office.

Considering this, the next step is to look into various...

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As we have talked about before, having efficient precertification practices can greatly improve patient experience. Moreover, the benefits of high-quality patient experience can be inestimable. Fundamentally, after all, this is a service industry with the primary aim of improving people’s lives. It is, in other words, about the patient.

As medical professionals, it is important to remember how far removed the average patient is from...

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AuthNet Launches 30-Day Challenge for prior authorization & eligibility verification services for healthcare practices, hospitals ACS & diagnostic facilities

The company saves valuable time and overhead costs; speeds patient access to needed healthcare services with outsources pre-certification/pre-authorization services.

Wilmington, DE - February 13, 2019 -- Healthcare providers across the country are feeling the crunch of prior authorization (PA) requirements for important patient care services from referrals and in-office procedures, to...

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Operating a standalone medical office can feel like running a small coffee shop across the street from a Starbucks. Whether yours is a rural practice treating myriad different ailments every day or a small office with a single specialty, it can be hard to find the happy balance between caring for your patients and caring for your operational costs. Outsourcing your insurance pre-certification needs to a specialty service like AuthNet is a great way to ensure your patients get the care they need while saving your practice...

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Medical care often gets a bad reputation for providing the exact opposite of what patients expect. Instead of being able to get in and out for a routine appointment quickly, busy patients often find themselves using up the entirety of their lunch hour or afternoon off and don’t even make it through to see the doctor. First and foremost, healthcare is about helping people. Don’t let things like office function hinder that primary mission. If you’re looking for ways to provide a better patient experience, try these tips.

Create a Patient-Forward Focus

Given the...

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The Academy Academy of Family Physicians calls prior authorizations “the number one administrative burden” for family physicians.

The AMA said the survey results show that prior authorization programs need reforms.

AMA Chair-elect Dr. Jack Resneck Jr. said prior authorization programs can help limit overprescribing and overuse of medical services. However, payers often require too much prior authorization.

Resneck gave an example of payers requiring prior authorization for generic medications.

Those processes are “a lengthy administrative nightmare of recurring...

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Reforming prior authorizations, developing value-based reimbursement models, and increasing patient health literacy are top priorities for an AMA-Anthem partnership in 2018.

The American Medical Association (AMA) and Anthem, Inc. recently announced that they will work together over the next year to streamline prior authorization requirements and improve the healthcare experience overall through provider and payer collaboration.

“Physicians caring for patients...

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In a recent letter to CMS, the AAFP discussed two topics of great importance to family physicians and their patients who will be enrolled in Medicare Advantage and Medicare Part D plans in 2019.

Specifically, the AAFP offered recommendations on how to improve prior authorization processes and suggested ways to ensure that family physicians are part of the opioid epidemic solution.

The Feb. 27 letter(4 page PDF) to Demetrios...

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Source: Becker's ASC Review

A troubling trend among insurance companies is threatening orthopedic ASCs across the country: narrowing payable diagnosis codes for osteoarthritis of the knee. Surgeons need to prove patients have a very specific diagnosis of knee osteoarthritis before payers will preauthorize surgery. Several payers will no longer preauthorize surgery based on "knee pain" and look for patients to meet certain criteria before an osteoarthritis diagnosis can be applied.

For example, Aetna considers patients with mild-to-moderate...

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Not Your Average PreCertification Services Company

When it comes to precertification services, we know you have several options to choose from, some of which may be geographically closer. However, when it comes to selecting the precertification company that’s right for you, there are other factors to consider beyond just services provided. You want a precertification service that understands the importance of building relationships with their clients and one that understands your objective is providing quality care to your patients by being available to tend to their needs. Enter...

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Why PreAuthorization?

You have more than enough to worry about at your medical practice. From caring for patients to keeping up with daily tasks and attending to employee matters, your medical practice is sure to have had the misfortune of dealing with medical backlogs. If this is or is becoming the case for you and your medical practice, let AuthNet’s precertification services take the stress out of the equation so you can get back to your pressing matters. But how does AuthNet deliver unsurpassed preauthorization? Take a look below...

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The Ins and Outs of Precertification

Those in the medical profession understand the importance of ensuring that each patient’s needs are met and met within a timeframe that allows for the most beneficial treatment and healing time for them. However, patients’ needs extend well beyond the quality healthcare services they receive from your healthcare center, hospital, or private practice; patients’ insurance and medical billing information is of the utmost importance when it comes to providing optimal healthcare services, whether the patient is in for a routine visit...

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Why Choose AuthNet For Your Medical Practice’s Precertification?

There are many reasons medical practices choose AuthNet for their medical prior authorization needs. Least among these reasons is the time saved by outsourcing your medical billing needs. But before we begin, let’s get into the nitty gritty of just what medical prior authorization is. The prior authorization services provided by AuthNet are designed to afford you and your staff more time to continue your practice and medical services, rather than becoming stuck with cumbersome medical billing processes...

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How AuthNet Makes Your Job Smoother

The medical field is one of the most demanding, draining, and rewarding professions out there. In a field where anything can happen and there’s rarely a dull moment, ensuring that processes and day-to-day tasks continue smoothing without running aground. And while unforeseen medical emergencies can derail your and your staff’s daily happenings, choosing to outsource your medical billing to AuthNet ensures that, no matter what your patients’ most immediate needs, you medical billing processes are taken care of. This affords you and...

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Time is Money

With the ever-increasing breakneck pace of today’s business and medical environments, optimizing your day-to-day activities and responsibilities is of the utmost importance when it comes to timely and accurate turnaround for a variety of processes. Specifically, medical billing can inadvertently take up more of your day than you may have originally planned, completely derailing your timeline for other crucial tasks, engagements, and responsibilities. Consider this: each unique patient has equally unique medical needs, thus necessitating specific actions...

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Save Time, Energy, and Money

Efficient time management is an integral part of getting the most out of our days, and better preparing for the days and tasks to come. Accordingly, optimal time management is crucial when performing medical billing tasks. AuthNet understands that there exists a myriad of tasks associated with medical billing and recognizes that many of these tasks hinder professionals’ ability to provide extraordinary patient services. Moreover, when you and/or your staff are free from dedicating hours to medical prior authorizations, you’re then free...

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Get Help for Your Prior Authorization & Verification Needs

What’s the biggest challenge facing your medical practice? The majority of practice managers and owners will tell you that it’s the process of pre certifications and verifications with insurance companies. This process can be time-consuming, slowing down the progress within your office and forcing you to focus on paperwork instead of patients. Unfortunately, ignoring this process isn’t an option, either. It can leave your office without the necessary cash flow that you need in order to become a thriving, busy practice....

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Save Time, Energy, and Money

Efficient time management is an integral part of getting the most out of our days, and better preparing for the days and tasks to come. Accordingly, optimal time management is crucial when performing medical billing tasks. AuthNet understands that there exists a myriad of tasks associated with medical billing and recognizes that many of these tasks hinder professionals’ ability to provide extraordinary patient services. Moreover, when you and/or your staff are free from dedicating hours to medical prior authorizations, you’re then free...

more
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Get Help for Your Prior Authorization & Verification Needs

What's the biggest challenge facing your medical practice? The majority of practice managers and owners will tell you that it's the process of pre certifications and verifications with insurance companies. This process can be time-consuming, slowing down the progress within your office and forcing you to focus on paperwork instead of patients. Unfortunately, ignoring this process isn't an option, either. It can leave your office without the necessary cash flow that you need in order to become a thriving,...

more
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Medical billing is a huge undertaking for most medical practices. It requires an incredible amount of data entry, follow up, and paperwork in order to get the right pre-certifications, prior authorizations, and insurance verifications that you need. Some medical practices think that this is just part of the business of running a medical practice. While it's true that this sort of insurance paperwork is a necessity, it doesn't necessarily have to be done in your office. In fact, doing it yourself could be negatively impacting your practice.

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