Talking to Patients: Precertification Basics

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 the bureaucracy and inner-workings of the medical world. The members of your team are highly-trained medical experts, which is, of course, invaluable. Nevertheless, it can pay to stay sensitive to the knowledge base of the average non-professional. It is often left in the hands of medical coverage companies to explain the details of coverage, including precertification.

Unfortunately, these explanations tend to be overly complex for many people who are first being introduced to the concept of precertification. Having an outline of the fundamentals of precertification — and why it matters — can be just another step toward positive patient experience. AuthNet is a fantastic resource for both medical professionals and patients to learn more about precertification. Contact us today to learn more.

Patient Experience and Precertification

It can be overwhelming for a patient to visit a medical office, and not just because of the anxiety around ailments and health issues. The wait times, the jargon, the atmosphere, all of these have the potential to put people on edge. It’s common to see this anxiety manifest in irritation or even anger on the patient’s part, which then puts an extra emotional burden on the practitioners and staff. This, in turn, creates a downward spiral that is negatively impacting everyone’s experience.

Staying in touch with how overwhelming medical visits can be on some people can help stop this cycle in its tracks. One way of effectively doing this is to keep patients informed on the steps and procedures. In particular, patients might be confused or frustrated at the precertification process and why that might delay or prevent timely procedures.

Precertification: Back to Basics

So, where to start when it comes to talking to patients about precertification? It is helpful to start with the basics.

In short, precertification is a request for coverage. More precisely, precertification involves the following:

  • A notification sent from us (a healthcare provider) to a health plan or insurance company
  • This notification is typically meant for elective, non-emergency services
  • We must then wait for the carrier to determine whether or not the procedure or services is covered by the patient’s plan
  • The carrier will typically proceed in one of three ways: verify coverage, request more information, or deny coverage

This can act as an accessible starting point for discussing precertification. There are, of course, subtle differences between precertification, preauthorization, and verification. The decision to launch into the details of each of these processes is largely up to the practitioner and the specific needs of the patient. We will explore some of the basics of preauthorization and verification and how to best discuss these with patients in future posts.

Precertification: The Authnet Difference

Reminding ourselves of how overwhelming these processes can be for the uninitiated can be helpful for improving everyone’s experience. Choosing AuthNet for outsourcing your precertification and preauthorization needs can make a huge difference, allowing you to save time, save money, and to focus on the things that matter. For more information on what we offer and the details of precertification, visit our services page. Our blog posts can also be a great resource to learn more for the sake of your patients. Contact us today for more information!