ASC Prior Authorization Services

Before embarking on a discussion about ASC Prior Authorization services, let us start by looking at the state of the industry. The ASC (Ambulatory Surgical Centers) market in the US has witnessed huge growth in the last couple of years. This growth has been driven by a few critical factors. One of the key reasons why many patients opt for ASCs is that they are cost-effective and convenient alternatives to hospital-based surgeries.

Advancements in medical technology have expanded the scope of procedures that ASC can undertake. When you are running an ASC, you often deal with a range of surgeries such as GI, ophthalmology, dermatology, urology, pain and neurology, orthopedics, and more. Apart from delivering optimal clinical care, you should also take care of your patients’ out-of-pocket expenses as medical costs are expensive in the US.

When providing treatment to your patients in your ASC facility, you should ensure that the insurance company pays the maximum reimbursements as soon as possible so that your patients are not required to pay any out-of-pocket expenses. This is exactly where ASC Prior Authorization Services play a crucial role.

For any ASC, prioritizing adhering to the payers’ guidelines regarding the facilities where services are rendered, treatment costs, medical selections, and coverage status for crucial procedures, is critical. However, in some critical situations, practices may need some exceptions. Without Prior Authorization for ASC, patients may face a substantial financial burden and providers may experience revenue loss.

When it comes to earning patient trust, focusing on providing the best patient care is not the only thing. You should also ensure the appropriate treatment plan is aligned with their insurance coverage. Educating your patients also plays a vital role in achieving maximized reimbursements.

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Most ASCs don’t realize the fact that before any anticipated diagnostics, medications and procedures, prior authorization should be acquired from the insurance company so that patients can receive maximized coverage.

Challenges for Prior Authorization for Ambulatory Surgery Centers

Streamlining a perfect prior auth mechanism has been always challenging for many small and mid-sized ASCs. Some of the common challenges faced by the majority of practices are-

A surge in ASC prior authorization services and staffing shortage:

The requirement for pre-auths has increased in recent years and showing no sign of slowing down soon.

A 2021 JAMA report found the fact that 84% of physicians admit that the number of prior authorizations for medications and medical services has increased during the last few years.

Unfortunately, at the same time, ASCs are dealing with ongoing staffing shortages.

 A recent AKASA survey found that 57% of healthcare centers have more than 100 open roles across their operations.

Ever-changing payer rules:

One of the critical challenges that most practices encounter is that payers frequently update their rules and guidelines. Furthermore, each patient’s health plan can have a different set of guidelines. Practices often find it difficult to stay in sync with all the latest payers’ guidelines.

Lack of transparency:

Lack of transparency from payers is another concern for many providers. A lot of ASCs find it challenging to determine whether certain medical services require prior auth or not.

Tedious job:

Prior authorization is a time-consuming, tedious, and repetitive process that requires your vital attention.

Every request involves several steps and sometimes it requires going back and forth multiple times with payers. Without a dedicated team, an ASC may feel overwhelmed with the tedious steps involved in ASC prior authorization services.

Administrative burnout:

A lot of ASCs report feeling stressed and burned out because of increasing patient volumes and staffing shortages.

Errors in benefits and eligibility:

Issues with coverage, codes, and late submission are not the only reasons behind denials. Any mistake in benefits and eligibility can also cause denials.

Sunknowledge: Outsource Prior Authorization Services for ASC to Us

We, at Sunknowledge, bring years of experience and skills to the table to streamline your end-to-end prior authorization practices. With close to two decades of experience, we have been providing top-notch Prior Authorization for Ambulatory Surgery Centers, large and small, across the 50 states.

As one of the leading ASC Prior Authorization Companies, we constantly leverage advanced technologies to minimize human errors, reduce turnaround time and boost your overall practice revenue significantly. Our comprehensive pre-billing approach includes meticulous follow-ups with physician’s office(s), contacting Payers to initiate the prior auth process and facilitating an expedited verdict.

With the highly competitive rate starting from $7/hour and operating on an FTE or Full-Time Equivalent model, we offer flexibility, transparency, and cost-saving to your practice.

Our skilled PA experts always remain updated with the latest payers’ guidelines to ensure the maximum returns for your patients.

Apart from showing excellence in handling PA tasks, we also scale up your operations quickly with the evolving needs of your ASC.

Unlike other RCM companies, we have acquired prior authorizations for complex medications and medical services. Our team of experts has managed to obtain prior authorization for a quasi-medical product like Botox.

Outsource Prior Authorization Services for ASC to See These Advantages Following:

Here are some of the vital reasons why many healthcare practices consider us as their trusted partner for Prior Authorization for ASC-

  • Achieve a 100% request-initiation rate
  • STAT requests initiated within a maximum of 15 minutes
  • Highly streamlined workflow
  • Substantial reduction in operational costs
  • Maximization of reimbursement
  • Up to 80% reduction in current billing costs
  • Seamless, zero-cost transition
  • Free dedicated Account Manager
  • No binding contracts required
  • Excellent references from reputable clients

So what are you waiting for? It’s time to ensure perfect patient satisfaction by providing your patients with the best treatments while billing them zero to minimum amounts. If you want to know more about ASC prior authorization services and other RCM services, give us a no-obligation call and we would like to explain our services to you.

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