Every year, practices lose millions of dollars that they can use for better infrastructure measures due to lack of result-driven prior authorization process. In allergy billing, insurance requirements such as repeat testing of allergy within a three year span requiring prior authorization is a pain area for most. A reimbursement policy with allergy testing is confined to a maximum of 60 tests in three years!
A member’s pharmacy benefits with therapies in oral desensitization are also a prolific instance! FDA approval and its benefits coverage needs complete prior authorization. Use of extra units above limits that are exceeding 80 units with multiple dose vials will require a comprehensive eligibility verification process.
The facts clearly state the need to have a synchronized practice management strategy that will set the benchmark for better revenue cycle management. It will be a clear statement to make that to improve on receivables, a quality authorization and verification methods will be a mandate.
The reduction of billing woes and lessening of A/R days need an assessment of the eligibility criteria and reduces errors with first time PA requests. Ensuring better denial management and spending money on useless accounts get check listed. Outsourcing of prior authorization in allergy services is a convenient solution for a lot of providers for staying live on competitive landscape!
Understanding of the claims adjudication process is a primary responsibility area and good medical billing companies address it. They comply with HIPAA and implement sound practices with their excellent processes. Allergy services will have to abide with the prescription & procedure process and an expert intervention gives them an edge.
Dynamic resources that restore sanity with timely checks and balances reduce money & time. Partnering with a vendor that has proficient payer side experience will be an excellent idea for allergy service vendors.
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