Blog

History of Precertification - Featured Image.jpg

Precertification has become a critical aspect of healthcare processing, ensuring that medical services are covered by insurance providers before they take place. Originally introduced to combat unnecessary medical procedures and control healthcare costs, precertification has evolved significantly over the decades. Understanding its history sheds light on the complexities of today’s healthcare landscape and the role of entities like AuthNet in streamlining this process.

more
Precertification vs Preauthorization Understanding the Differences.jpg

Navigating the complexities of healthcare can be challenging, especially when it comes to understanding prior authorization and insurance precertification. AuthNet simplifies these intricacies for hospitals and healthcare providers. While the terms are often used interchangeably, they serve distinct purposes within the healthcare system.

more
How to Get Precertified for Medical Care - Featured Image.jpg

At AuthNet, we understand that navigating the complexities of healthcare precertification can be daunting. Medical precertification is essential for ensuring that the services you need are approved by your insurance provider before they are rendered. Our goal is to guide you through the process, helping you avoid unexpected expenses and delays in your care.

more
How AuthNet CARES Hero.jpg

At AuthNet, we understand the challenges that physicians, medical office staff, and other professionals face when it comes to revenue cycle management, healthcare billing, insurance preauthorization, and benefits verification. That's why we are dedicated to providing a seamless and efficient process to ensure our clients can focus on what matters most — providing exceptional patient care! Our approach is guided by our core values, encapsulated in the acronym C.A.R.E.S.

more
group of smiling medical staff

Efficiency is key when it comes to running a successful medical practice. From streamlining patient intake to optimizing insurance authorizations, every aspect of your workflow can impact your overall performance. Here are four tips from AuthNet to help you improve your practice's workflow and enhance productivity.

more
authnetfeature.jpg

Prior authorization can be a time-consuming and complex process for healthcare providers, taking away valuable time and resources from patient care. That's where AuthNet comes in – a trusted provider of prior authorization services that allows healthcare professionals to focus on what matters most: their patients. In this blog, we'll explore four industries that can benefit from AuthNet's services.

more
Medical front desk staff checking in patients

As a medical professional, you understand the importance of providing timely and efficient care to your patients. However, one of the biggest challenges you may face is the process of precertification. In this blog post, we provide important information about precertification as well as opportunities to learn more about how AuthNet can streamline the process for your medical practice.

more
doctor using a computer

In the fast-paced world of healthcare, where every second can make a difference in a patient's life, the last thing medical professionals want to deal with is administrative hurdles. These necessary but time-consuming tasks can often divert precious resources away from patient care.

That's where AuthNet comes in. We collaborate with physicians, hospitals, ambulatory surgical centers, and other healthcare providers to simplify the authorization process. But how do you know when it's time to call a pre-authorization service like AuthNet? Let's explore the signs that indicate it's time for your medical practice to seek professional assistance.

more
diagnostic imaging

Navigating the world of healthcare procedures can be complex, and one important aspect to consider is precertification. Understanding the precertification process can help patients and providers mitigate potential complications and ensure a smoother healthcare experience. AuthNet is a leading provider of prior authorization processes and services for hospitals, ambulatory practices, and ancillary healthcare service providers across the country. In this blog post, we will shed light on four common medical procedures that require precertification.

more
nurse at computer

It’s no secret that insurance preauthorization can be a complex and confusing process for both healthcare providers and patients. To make matters worse, there are several common misconceptions surrounding insurance preauthorization that can further complicate matters. In today’s blog, we will explore four of these misconceptions and shed light on the role that AuthNet plays in providing streamlined preauthorization services to hospitals and private practices. Read on to learn more!

more
healthcare workers

As a healthcare professional, managing preauthorization can be time-consuming and challenging. Outsourcing preauthorization can free up your time, allowing you to focus on your patient's care while ensuring that you receive faster approvals and increased productivity in your office. Authnet is a nationwide company delivering faster and easier medical prior authorizations, insurance authorizations, and benefits verification.

more
Insurance Preauthorization Hero.jpg

When it comes to healthcare, insurance preauthorization services are essential for helping healthcare providers get the most out of their claims. AuthNet offers preauthorization and insurance authorization services across the United States, so you can be sure you’re receiving the best possible care. Let’s explore the advantages insurance preauthorization services offer.

more
dreamstime_xxl_28705013.jpg

When providing medical care to patients, it's essential to prioritize the patient experience. Patients should never be made to feel like a burden or an inconvenience, and that's why understanding their needs is vital to creating a positive atmosphere in your facility. AuthNet is here to talk about the four tips for medical professionals to improve their patient experience. Learn more about our insurance authorization process today!

more
M10325 Why Choose Authnet Featured Image.jpg

Medical professionals undergo many time-consuming tasks that take away precious time from patient care. Some of these tasks include eligibility verification and pre-authorization, as insurance companies often make it difficult to establish a smooth process, which you do not want to deal with as a medical professional. AuthNet is a leading provider of prior authorization services and we are here to help your facility overcome the barriers insurance creates throughout the process. Read on to learn why you should partner with us, and visit our website to get started today!

more
Featured Image.jpg

When you need prior-authorization services, having a team of professionals at your side is imperative. AuthNet understands that handling insurance pre-certification requests and billing processing is not what you want to do each day, so our team is here to handle it for you! This gives you more time to treat your patients and operate your office each day. Learn more about the top four advantages of AuthNet here and contact us to get started!

more
Website Hero BG.jpg

Let Authnet Focus On Prior Authorizations So You Don't Have To

Request A Demo

more
national-cancer-institute-NFvdKIhxYlU-unsplash-1-60fb07f4baea4.jpg

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 healthcare insurance on the part of service providers. Pre-authorizations can be time-consuming and expensive at the same time. Because of this administrative burden, many doctors and health care providers outsource necessary tasks to third-party medical billing service providers to cut operational costs and focus more time on providing better medical services.

Provide Better Patient Experience

A doctor’s time and attention should be primarily focused on caring for patients rather than managing insurance prior authorization paperwork. Prior authorization can be a lengthy process that requires multiple time-consuming steps to complete. From securing the right documents to dealing with long waits, it can easily take huge chunks of time from doctors and staff, time that could have been spent on providing exceptional patient service.

more
AuthNet-blog-featured-image-6-605e55f360cb2.jpg

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 about the prior authorization, check out this blog post).

In today’s blog, we are going to be covering who can process prior authorizations, what the pharmacist’s role is in the process, and whether or not a prior authorization can become a function of pharmacy practice. Read on to learn more, and if you are looking to have prior authorizations outsourced for your medical practice, be sure to reach out to our team at AuthNet today for a free demonstration of our prior authorization services.

more
AuthNet-blog-featured-image-5-602c06ac8c910.jpg

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.

1. Breaking the Law

While this one may be common sense to some, others forget that your health insurance likely will not pay for healthcare costs you racked up while doing something illegal. This is called the illegal act exclusion, and if your health insurance policy has one, it means that you will not be covered if you need medical attention due to an illegal act.

A great example of this would be if you burned yourself. If you did this lighting up the grill at a family picnic and racked up a $2,000 medical bill, you are most likely going to be covered. But, if you burn yourself while freebasing cocaine and rack up a $2,000 medical bill, that bill will be coming to you if your health insurance policy has an illegal act exclusion.

more
AuthNet-blog-featured-image-4-5fe35b8ddaf00.jpg

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 the medical service or medication. Not only does this cause massive strain on the physician, but in addition to the documentation, preauthorization policies differ among insurers.

But there are steps that physicians can take in order to obtain prior authorizations in an efficient manner and prevent denials that cause further setbacks, which we will be discussing in today’s post. If you have any further questions about prior authorizations and how you can make this process easier for your practice, please don’t hesitate to reach out to AuthNet today. We are a prior authorization provider and would be more than happy to assist your practice with this task so you can focus on your daily operations and providing your patients with the care that they deserve.

more
authnet-blog-featured-image-5f8883e7d46eb.jpg

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 someone who doesn’t have experience in charge of having them completed. Not only will this be much more time consuming, but it can also lead to unnecessary mistakes. Instead, hire a company whose main focus is prior authorizations and has the expertise in this area. Not only does outsourcing this process save your medical center money in the long run, but because prior authorization specialists are continuously trained on new policies and guidelines, it will prevent you from the burden of preauth training. It also alleviates the headache that typically comes with having stacks of paperwork to fill out on top of a long day of work.

more
AuthNet-blog-featured-image-3-5f288257d1bac.jpg

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 detrimental effect on the income of a practice. In today’s blog, we will be discussing how and why hiring a company to handle your prior authorizations is key to speeding up the prior authorization process, saving your practice and your patients both time and money.

They simplify pre-authorization services.

Considering how much time your staff likely spends on pre-authorizations, it makes no sense to hire someone who is inexperienced with these processes to be in charge of this activity or spend a large amount of time (and money) performing interviews on potential candidates for the position. Instead, when you choose to outsource these services with an expert team in medical billing like AuthNet, you are not only speeding up the process but simplifying it. When you work with our team, all you have to do is enter your patient’s appropriate demographics, diagnosis, and CPT codes into our secure portal which prompts our team to begin the process. Then, our pre-authorization insurance specialists take care of the entire process from start to finish (including follow-ups and appeals) so you don’t have to.

more

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 authorization specialists.

How does the prior authorization process work?

  1. A healthcare clinician determines that a patient needs a specific test, procedure, medication, or device, and then checks a health plan’s policy rules in order to determine if a prior authorization will be required for the course of treatment that is prescribed.
  2. If it is required, the provider will then need to formally submit a prior authorization request form and sign it to attest that the information is true and accurate.
  3. Clinical and healthcare billing systems are rarely integrated, so healthcare provider staff will need to start manually reviewing the rules of prior authorizations for the specific insurance plan associated with the patient. These rules vary from health plan to health plan, and even differ from plan to plan with a specific payer. These rules also change frequently, so a healthcare provider’s administrative staff may be referencing out-of-date rules that lead to errors.
  4. If the healthcare provider confirms that the prior authorization is not required, they can submit the claim to the payer (which does not necessarily mean that the claim will be approved).
  5. On the other hand, if the healthcare provider confirms that the prior authorization is required, they will need to track down more specific information pertaining to each CPT code that is applicable to the prescribed treatment plan, as well as a number assigned by the payer that corresponds to the prior authorization request. These steps are typically done manually through a variety of phone calls, emails, and faxes.
  6. Without outsourced prior authorization services, the responsibility falls on the provider to continue this process and follow-up with the insurance company until there is a resolution to the request, whether that is an approval, redirection, or denial. This part of the process often leads to significant wasted time and effort due to it being unstructured and improvised.
more
authnet-blog-featured-image-1-5e9f55096917d.jpg

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 medical center is looking for assistance with pre-authorization services during this time (or anytime), please do not hesitate to give AuthNet a call. We would be more than happy to partner with you to make the process as smooth as possible for both you and your patients.

Tip #1: Ensure that your business information is both available and up-to-date.

Due to the fact that COVID-19 has caused many practices to temporarily change some of their standard business practices, it is important to keep any business information updated online. Doing so will allow both current and prospective patients to stay in the loop.

more
authnet-blog-featured-image-5e961822f052e.jpg

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 appointments and canceled surgeries all at once.

While obstacles are mounting, supplies are running slim, and staff are becoming infected with the virus themselves leaving many hospitals short-staffed — one way that healthcare facilities can take a little bit of the load off is to outsource prior authorizations. In today’s post, we will be going through a few of the many ways that hospitals and other medical centers are being affected by COVID-19, and how working with AuthNet’s prior authorization services can help physicians continue focusing on what matters the most — their patients — instead of having to worry about paperwork.

more

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 considerations will assist in the management of vital healthcare resources during this public health emergency.

Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient. To reduce the risk of spread and to preserve PPE, we are recommending that all non-essential dental exams and procedures be postponed until further notice.

A tiered framework is provided to inform health systems as they consider resources and how best to provide surgical services and procedures to those whose condition requires emergent or urgent attention to save a life, preserve organ function, and avoid further harms from underlying condition or disease. Decisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have direct responsibility to their patients. However, in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered. These recommendations are meant to be refined over the duration of the crisis based on feedback from subject matter experts. At all times, the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators should be considered, even in areas that are not currently dealing with COVID-19 infections. Therefore, while case-by-case evaluations are made, we suggest that the following factors to be considered as to whether planned surgery should proceed:

more
blog-featured-image-1-5dc5adde819f1.jpg

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 for both medical centers and patients.

Real World Example

Say you go into the doctor to discuss some flu-like symptoms you have been having. You are then prescribed medication and head over to your pharmacy to pick up your medication. Upon arrival, the pharmacist proceeds to tell you that your prescription won’t go through your insurance company without prior-authorization. Now, not only does your stomach hurt, but now you have a headache just from trying to get your medications. In most cases, your pharmacist will then contact your doctor and let them know that your medication requires prior authorization. Your doctor will then contact your insurance company and fill out the appropriate forms needed for approval. Sometimes, the insurance company may need you to fill out additional paperwork. This process can often take days to complete, even weeks — and no one wants to have to wait for relief when they are feeling under the weather. The reason for this is because many medical centers only have one or two staff members who are in charge of filing all of their paperwork — which can add up quickly. That is where our team and state-of-the-art software at Authnet comes into play.

more
dreamstime-xxl-115506969-5d433c8e77897-942x628.jpg

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 spending thousands of hours on pre-authorization services.

But, again, it’s not just time. It’s so much more than that. We’ve written before about the true costs of pre-authorization. It can be incalculable once you start to consider things like patient experience and employee satisfaction. Even in purely monetary terms, however, you’re looking $28,000 in annual costs per provider when you choose to handle pre-authorizations in-house. AuthNet will not only help you save money, but we can improve the entire experience of your office, from employees to patients. So, let’s take a look at what you can do with all that extra time you’ll get!

more
dreamstime-xxl-47874984-5d235f7089c00-946x628.jpg

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 play in care delays. According to a report released last year from the American Medical Association (AMA), precertification issues are associated with 92 percent of care delays. There’s reason to be optimistic for institutional changes to help with these (as we looked at in our previous blog). Additionally, outsourcing precertification through AuthNet can help mitigate the ample costs of precertification. Be sure to contact us to learn more about making your office more efficient. In the meantime, let’s take a closer look at the effect of precertification and care delays.

more
dreamstime-xxl-592935-5d234daa76834-942x628.jpg

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 with pre-authorization services for Medicare Advantage plans. It includes protections for beneficiaries and a strategy for making real-time decisions in order to avoid the lengthy waiting periods associated with pre-authorization. In short, the bill is attempting to simplify the process for pre-authorization for Medicare Advantage plans.

more
dreamstime-xxl-85188198-5ce31e0c0bd0e-942x628.jpg

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 prior-authorization services. AuthNet offers top-tier prior-authorization services, and there are many reasons why we stand apart. This blog will take a look at just a few. Here are three reasons to choose AuthNet for your prior-authorization services.

1. Expertise

The professionals at AuthNet bring you the absolute best service. We provide better insurance authorization processes and smarter methods in obtaining medical preauthorizations so that everything functions better for everyone. We are able to do this because all of our insurance authorization specialists receive thorough training and develop a deep understanding of the pre-authorization process.

more
dreamstime-xxl-138808023-5cb8b4975d22b-942x628.jpg

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.

more

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 surgeries and diagnostic tests. To celebrate attending the 2019 HIMSS event in Orlando, leading provider of outsourced prior authorization services, AuthNet, is stepping up its efforts to help tackle this costly problem with the launch of its 30-Day Challenge: a month-long, risk-free trial program that allows healthcare facilities to test the outsourcing waters and measure real-time cost-savings on PA activities.

A recent AMA survey found a number of alarming insights about the impact that prior authorizations have on healthcare providers trying to obtain them and the patients needing them for access to care:

more
Authnet-Blog-Money-Saving-Measures-5b44ceb76dcb9.jpg

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 money. Here’s how it works:

Timely Processing

How many appointments in the last month have needed to be canceled last minute because an insurance prior authorization has not been processed or approved? When appointments are canceled at the last minute, not only is your patient’s time wasted, but so is your staff’s. Each time an appointment has to be canceled or rescheduled, that is likely an hour or more of the physician’s time wasted because it can be nearly impossible to fill those time slots at last minute. At AuthNet, a key part of our prior authorization process includes following up with every request within 24 to 48 hours. We undertake the follow-up to minimize appointments that need to be canceled because of unprocessed requests.

more
Authnet-Blog-4-Ways-5b44ceba4531f.jpg

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 demands of operating any business, especially one as complex as a medical office, it can be surprisingly simple for the patient focus to slip by the wayside. HIPAA compliance, medical billing requirements, and every other sundry aspect of daily operations can feel imperative. Somewhere in there, little touches that speak to patient experience can easily slip through the cracks. If you are looking for ways to provide a better overall experience, step one is to shift the focus. All staff members should remember that they are ultimately in a customer service industry — and act accordingly. This means your front desk staff, of course, but it also means doctors, nurses, insurance authorization staff, and anyone else who may run into a patient in the halls.

more

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 paperwork, multiple phone calls and bureaucratic battles that can delay or disrupt a patient’s access to vital care.”

Over-demanding pre-authorization can have medical care consequences for patients. In addition to the vast majority of physicians who said prior authorization delays patient access to necessary care, 78% of physicians said prior authorization can result in patients “abandoning a recommended course of treatment.”

Prior authorization can also cause administrative headaches for physician practices, with 84% of physicians saying prior authorization burdens are either high or extremely high.

more

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 across the country have many ideas about how we can reduce healthcare costs and administrative burdens while improving clinical outcomes, and we need the collaboration of Anthem and all health plans to implement those strategies,” stated Gerald E. Harmon, MD, AMA Board Chair. “The AMA looks forward to finding common ground on ways to improve the delivery of affordable, high-quality, patient-centered care.”

The industry heavy-hitters intend for the partnership to advance prior authorization priorities detailed in a consensus statement earlier this year.

more

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 Kouzoukas, CMS principal deputy administrator, was signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala.

The AAFP was responding to a document the agency issued on Feb. 1,(www.cms.gov) titled "Part II of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies and Draft Call Letter," that covers policy and technical changes to specific CMS programs.

The response complements a Jan. 16 letter(12 page PDF) to CMS Administrator Seema Verma that covered other areas of concern.

more
Authnet-Blog-Precertification1-5953e6054d7be.jpg

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 osteoarthritis, as calculated by Outerbridge classification I and II, with knee pain as well as mechanical symptoms from loose bodies and meniscal tears candidates for arthroscopic debridement based on medical necessity. The payer considers "arthroscopic debridement for persons with osteoarthritis presenting with knee pain only or with severe osteoarthritis (Outerbridge classification III or IV)" to be experimental.

"If you want to do arthroscopic debridement for people with osteoarthritis presenting with knee pain, you'll have a hard time getting that paid by payers," says Terry Coleman, president of in2itive Business Solutions. "You have to get the preauthorization, and insurance companies are narrowing the payable diagnosis codes. We hope this isn't the beginning of a trend across the board, and we advise ASCs to monitor insurance company policies."

more
authnet-topreasons-59bc48795b7d1.jpg

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 AuthNet and our unrivaled precertification services.

When you choose AuthNet for your precertification needs, you’re not only choosing a company with years of professional experience, but you’re also choosing a precertification company that empathizes with your need to provide the best care and services possible. We provide top-of-the-line professional precertification services so you can focus on what matters most to you and your practice: taking care of patients who are in need. AuthNet has cultivated lasting relationships with numerous clients in all corners of the country, and we’re proud of the quality assistance we’ve provided these medical professionals. For some of the reasons these medical professionals continue to choose AuthNet for their precertification services, take a look below.

more
Blog-Precert-5984ecff8b218.jpg

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 for an overview of the precertification services we provide.

Click Here to Contact AuthNet Today

How We Can Assist

Our team of dedicated preauthorization experts is well-equipped and experienced to handle your medical prior authorization needs. We can handle nearly any volume of insurance precertification claims, and are here to assist with streamlining your needs. You won’t need to follow up with payers once the process has been completed; we handle all of that. We know that this phase can be stressful and time-consuming, which is why we proudly take this role on, allowing you to recoup your valuable time and resources, as well as not be distracted from caring for your patients and tending to other daily tasks and to roll with the punches of unforeseen circumstances.

more
Authnet-Blog-Featured-IMGs-percentification-595eb0734119d.jpg

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 or is requiring emergency surgery. Whatever the patients’ needs, your healthcare services are their lifeline. Ensuring that these patients receive not only excellent healthcare services but equally excellent insurance authorization services requires time, dedication, and focus. While you and your team are dedicated to providing these services, sometimes insurance matters can pile up, straining precious resources. Auth-Net is here to help. Continue reading to learn how Auth-Net’s precertification services can benefit you and your patients.

Why Precertification is Important

There are myriad reasons why offering precertification services benefit you and your patients but ultimately, medical precertification allows you and your staff to provide your quality medical services without the additional stress of being bogged down by numerous precertification inquiries. Additionally, precertification determines if a patient’s medical procedure is necessary and meets the qualifications of their insurance plan. Further, precertification ensures that unnecessary out-of-pocket expenses are avoided. Often, precertifications save both you and your patient’s time and money by finely combing through insurance plans to get the most accurate understanding of the plan as possible. Finally, precertification ensures that patients receive the medical professional best suited for their condition. This means no chance of a patient finding their way into your office who could best benefit from another medical professional.

more
Authnet-Blog-Precertification2-5953e60800dc0.jpg

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 that can often hinder your productivity and workflow. When you outsource with AuthNet, you’ll be receiving the highest quality medical prior authorization services that ease the billing burden on your and your practice's end, allowing you to turn your attention to more immediate, pressing medical matters. Curious about the benefits brought about when you choose to entrust AuthNet with your medical billing needs? Continue reading to learn the most pressing reasons medical practices across the States turn to AuthNet for their insurance precertification needs.

Click Here To Request A Demo Today

more
Authnet-Blog-Precertification1-5953e6054d7be.jpg

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 your practice to continue caring for and treating patients without the added stress of scrambling to delve into the often hefty load of medical billing. With AuthNet’s unsurpassed quality concerning medical precertification, you’ll never have to worry about whether or not your patients’ medical billing has been taken care of. Curious about why choosing AuthNet for your prior authorization services is not only in your best interest but also your patients’? Continue reading to learn more about how AuthNet’s tried and trusted track record can work for you and your medical practice.

Click Here To See All Of AuthNet’s Precertification Services

more
Authnet-Blog-Featured-IMG-Billing-591a1541ef2aa.jpg

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 taken for their medical situation. If you and your medical practice are overburnded with an influx with highly-specified medical billing procedures, this can stall your billing queue, signaling a host of complications not only for you and your practice, but the patients for whom you seek to treat. If a patient’s medical billing is backed up, this further delays offering your high-quality services to another (or more) patient(s), signaling a snowball effect of runaway medical billing issues. Fortunately, AuthNet understands the difficulties and specificity that comes with quality precertification processes, and offers medical billing precertification to keep your medical practice or office running smoothly. Curious about how AuthNet can help you and your business provide unmatched precertification medical billing, in turn creating a better patient experience? Read on to learn more about AuthNet’s services, and how they can aid you and your practice.

more
OptimizedBilling-58e250266d9c0.jpg

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 to dedicate more time to your patients. Curious about how AuthNet can provide you and your medical practice with the finest prior authorization services available? Continue reading to learn more, or check out the services we proudly offer.

The AuthNet Difference

Insurance precertification is often a laborious and cumbersome process that eats our time before we notice. However, AuthNet provides clients with outstanding prior authorization services, in turn affording you and your staff the freedom to pursue other pressing tasks and to provide the utmost in patient care. When you choose AuthNet for all of your prior authorization processes, you’re also selecting the finest in client-focused insurance precertification; AuthNet works closely with clients to better understand their needs, goals, and concerns in order to provide clients with the timeliest, most reliable medical preauthorization available. After an initial conversation and/or meeting, AuthNet provides you and your staff with patient detail verification processes, including:

more
blog-wecanhelp-58c96c107360e.jpg

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. It’s frustrating for patients, too, who may have to delay procedures and treatment while they wait for your office to get the authorization you need from the insurance company. Overcoming the difficulties of precertification and insurance verification is exactly how AuthNet can help you build a more successful medical practice.

We Can Help You Focus on Patients, Not Paperwork

If you feel like your practice is drowning in paperwork, it’s time to contact AuthNet. We’ve built a business that’s dedicated to taking over the preauthorization and verification process for medical practices across the country. We know that you started your practice because you wanted to help your patients, not do the paperwork that’s required by insurance companies. Trusting that process to AuthNet means eliminating a great deal of the paperwork that slows down your office and pulls your attention away from treating the patients in your care. We can even help increase your cash flow so you can continue to build a successful practice. It’s a benefit to your patients, too, who will get answers from their insurance providers faster about getting the care required for their well-being.

more
OptimizedBilling-58e250266d9c0.jpg

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 to dedicate more time to your patients. Curious about how AuthNet can provide you and your medical practice with the finest prior authorization services available? Continue reading to learn more, or check out the services we proudly offer.

The AuthNet Difference

Insurance precertification is often a laborious and cumbersome process that eats our time before we notice. However, AuthNet provides clients with outstanding prior authorization services, in turn affording you and your staff the freedom to pursue other pressing tasks and to provide the utmost in patient care. When you choose AuthNet for all of your prior authorization processes, you’re also selecting the finest in client-focused insurance precertification; AuthNet works closely with clients to better understand their needs, goals, and concerns in order to provide clients with the timeliest, most reliable medical preauthorization available. After an initial conversation and/or meeting, AuthNet provides you and your staff with patient detail verification processes, including:

more
blog-wecanhelp-58c96c107360e.jpg

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. It's frustrating for patients, too, who may have to delay procedures and treatment while they wait for your office to get the authorization you need from the insurance company. Overcoming the difficulties of precertification and insurance verification is exactly how AuthNet can help you build a more successful medical practice.

We Can Help You Focus on Patients, Not Paperwork

If you feel like your practice is drowning in paperwork, it's time to contact AuthNet. We've built a business that's dedicated to taking over the preauthorization and verification process for medical practices across the country. We know that you started your practice because you wanted to help your patients, not do the paperwork that's required by insurance companies. Trusting that process to AuthNet means eliminating a great deal of the paperwork that slows down your office and pulls your attention away from treating the patients in your care. We can even help increase your cash flow so you can continue to build a successful practice. It's a benefit to your patients, too, who will get answers from their insurance providers faster about getting the care required for their well-being.

more
blog-medicalbilling-58c96c166eda0.jpg

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.

more