- December 14, 2021
- Posted by: Thomas Anderson
- Category: Prior Authorization
If getting your prior authorization managed by an inadequately trained in-house staff is bad enough, outsourcing it to an inept prior authorization company can be a lot worse. It can lead to a waste of both time and money, and is likely to leave your affairs in a shape that is no better than before.
What every medical practice and service provider will agree about is that prior authorization is a crucial part of your entire revenue cycle. A botched attempt at the process will invariably lead to denials, and therefore, to missed opportunities of getting reimbursed by insurance companies. So when you decide to enlist professional help from an external agency, be sure that you are choosing the right prior auth company to partner with.
The following 5 quick checks will help to eliminate mistakes while selecting.
1. How long have they been in business?
Chances are, as you start looking around, you will discover quite a few new names on the block. What they lack in experience, they will try to make up for with attractive pricing, bundled offers and inspiring promises. However, if you are serious about cutting down denials and increasing collections, it is a good idea to steer clear of the newbies in the business and choose a prior authorization company that has been around for at least 10 years. Remember, when it comes to handling prior authorization requests, experience matters more than anything else.
2. What are their clients saying?
Play a little Bogart before you proceed. Try to find about a company from the clients they have already served. Most prior authorization service providing companies with a genuine reputation will be happy and proud to share references with you. Ask to see customer testimonials, ratings and reviews. And the more you find such stuffs, the better. Not only will it help you feel more confident in hiring a new company, but will also serve as an effective yardstick to judge their quality and capabilities.
3. Read the fine print
Engaging third party services for pre-authorization will come with a few terms and conditions. They will vary from one pre-auth company to another. One of the most problematic clauses in such a typical contract is the ‘minimum term of engagement’ that is required before you can decide to discontinue or continue with your appointed vendor. It is advisable to be wary of such binding clauses. Remember, no prior authorization company confident about the quality of its services will try to tie you down with such clauses.
4. A word about data safety
Choosing a partner to outsource your prior auth needs to will mean sharing confidential patient data. So when you have a company in mind, be sure to ask them about what kind of measures they have adopted to keep patient information safe and secure, before you sign the contract. Data security is of paramount importance when it comes to working with patient data. Look for HIPAA / HITECH compliance, ISO certifications and other pertinent credentials. Every prior auth company worth its salt will never compromise on the issue of data safety.
5. Avoid price surprises!
Finally, ensure cost transparency before taking the leap. In other words, be sure to fully understand exactly what services you will be getting and you will be billed for them. You can opt for an hourly rate, or agree to pay a fixed percentage of collections. Do the math before you sign and choose what works best for you and your specific requirements. Also watch out for any hidden fees or surprise charges.
Getting a competent, skilled and professional prior authorization company as an extension of your operations can bring significant changes in your revenue collection efforts. You will also be surprised by the amount of time such an association can free up for you. So, choose well and watch your practice grow more profitable with every passing day.