How to Better Prior Authorization for DME with Health Insurance Understanding

November 07,2016 / By Josh Knoll

Josh Knoll

Ensuring quality practice management and health administration remain a challenge for a lot of providers & multi-specialty practices. Inpatient admissions also require quality checks & balances and precertification inquiry submissions with EDI must be complemented with excellent processes. Prior Authorization still remains a pertinent challenge area in US healthcare!

On a given week, any provider spends almost 20 hrs on requirements of prior authorization. Almost 20% rejections in first time procedures and drugs are largely due to absence of better denial management.  It clearly emphasizes the lack of a strategic vision to minimize costs that can be used for quality patient care.

Getting prior approval for DME is a tedious process that involves detailed understanding of insurance policies today. Managing confidentiality of patient information and getting competent processes in medical billing is the primary onus of a provider that directly impacts revenue cycle management.

To prescribe a specific form of medication, obtaining approval from the health plan insurer isn’t easy for a DME service provider with modern quality metrics. There are billing companies that provide clarity with medical claims establishing reimbursements in a consistent manner. Looking at the present scenario, any RCM company in healthcare and its relevant partnerships with TPA’s will be worth considering!

For a better financial return, a provider will be benefited with a vendor that sets the tone with a streamlined pre-authorization process. It gives their accounts receivable clarity reducing loopholes that hinders collections. Outsourcing of authorization and verification services is fast becoming a consistent practice with leading DME providers.

The relationship management methods with insurance companies are also upgraded with a good medical billing partner inducing transparency in practice management. Reducing mistakes with account management can be settled at the onset if you are willing to correct your approval process. Engaging a vendor expert in handling prior authorization will be a good road map.

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