The Secret Key to Success in Prior Authorization for Radiology Practices

December 05,2016 / By Natalie Simpson

Natalie Simpson

With the advent of ICD 10, the probability of making mistakes in claim submission has increased. Therefore, one witnesses too many cases of authorization denials these days, resulting primarily from coding errors or incorrect information. The main focus of a well-managed radiology billing operation is to submit claims for services punctually and in the proper, required format, and receive reimbursement as fast as possible. And this is the main impetus behind the growing drive to hire third party experts for Prior Authorization.

CT (computerized axial tomography), MRI (magnetic resonance imaging), MRA (magnetic resonance angiography), PET (positron emission tomography), cardiac nuclear medicine studies (e.g. nuclear cardiac stress test) are the services that require a pre-approval from the ordering physician.

In most cases, these are highly time-sensitive procedures and most often than not, need to be completed within a specified time in order to initiate the necessary treatment plan. Errors made while requesting prior authorization never help. They cause delays that could have been avoided, and only prolong the waiting period for the approval to arrive from the insurance company. And when it stretches for too long, out-of-pocket expenses become inevitable, not to mention the agony that the waiting period has already caused to the patient.

Errors in prior authorization for radiology stem mainly from mistakes made while filling in the request form (which is usually done in a prescribed, pre-determined format), ignoring the latest guidelines, or missing out on providing all the supporting documents that are required. The real problem is, such slips are not easy to avoid, because they stem from a simple lack of skill, time or knowledge. Regular in-house billing staff, employed by radiology practices, often falls short in meeting the desired standards in these areas.

The better alternative, naturally, turns out to be outsourcing the task to a dedicated prior authorization expert, or an entire team of such professionals as dictated by the volume of work. Insurance companies have a very low threshold for tolerance in matters involving the kind of errors that plague the billing and claim submission scenario today. So why take chances and lose time, and money, in getting requests denied, sending and resending them many times over till the desired approval is obtained? Radiology practices are well-advised to seek out dedicated, specialized assistance in such matters, and not just cut denials and improve overall collection from their business, but also free their administrative staff for more important things to take care of.

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