Hospitals Prior Authorization Services

Comprehensive Prior Authorization Services for Hospitals from Sunknowledge

All hospital based services – both inpatient as well as outpatient, require prior authorization services for hospitals, unless the service or the medical procedure is delivered in an emergency setting. In fact, be it outpatient hospital based requests of a service or elective inpatient admissions, the need for hospital prior authorization services is a crucial factor for ensuring timely and uneventful reimbursements afterwards.

Key findings

  • Approximately 80% of Medicare enrollees are enrolled in plans requiring prior authorization for at least one Medicare-covered service.
  • Around 70% of enrollees must undergo prior authorization for services such as Durable Medical Equipment (DME), Part B drugs, skilled nursing facility stays, and in-patient hospital stays.
  • Roughly 60% of enrollees are in plans necessitating prior authorization for services like ambulance transport, home health procedures, and lab tests.

More than half of enrollees are in plans mandating prior authorization for mental health services.

In light of these statistics, it is clear that healthcare providers, and hospitals in general, must prioritize a streamlined prior authorization approach to ensure improved chances of securing fuller reimbursements and enhancing patient experiences.

However, the rising concern that most hospital prior authorization companies are encountering today is finding the right resources. Finding the right operational extension is becoming a huge challenge for many hospitals looking to outsource their prior authorization tasks. This is because typical prior auth tasks – from document filing, to following up with the payers and creating a process that quickens the process of prior approval – are difficult to accomplish, time-consuming and cost a ton. It is often seen that physician and patient wait times increase while the provider loses out on precious time and eventually on money.

How Can We Help?

Transform your Revenue Cycle with our legendary support at just $7/hr.* (all inclusive) guaranteed locked-in rate till 2026!

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Outpatient Procedures that Need Prior Authorization for Hospitals

  • Cosmetic or reconstructive surgery and other procedures
  • Pulmonary rehabilitation and outpatient cardiac treatment
  • Home healthcare services: agency visits, sleep studies, hospice care excluding home visits that are billed as an E&M service.
  • Ambulatory surgery center based infusion services as well as associated medications
  • Genetic testing and elective transportation services
  • Durable Medical Equipment services
  • Stem cell and organ transplant procedures
  • Mental & behavioral health treatment
  • Radiology services
  • GI medication
  • Pharmacy
  • Injectable medication, and others

It is quite evident that for a hospital, managing patients and prioritizing a better practice management effort is a big challenge. Moreover, the lack of expert resources is a huge setback for healthcare providers at present who are struggling with obtaining prior authorization. Rising operational costs, pending backlogs, and denials are posing a serious threat to many for health care today. The need of the hour is to find someone consistent and trustworthy, a partner that can deliver the right support in your hospital prior authorization process, like Sunknowledge Services Inc.

Partner with Us for Seamless Hospital Prior Authorizations Services

Worry no more when we are by your side! We are a complete healthcare RCM service destination. We understand what it takes to transform your cash flow. Our team of experts fully comprehends present-day industry challenges, drivers and restraints, and extends superior support in outpatient hospital prior authorization. We help you gain the right visibility in your front-end efforts, and help you save time and money.

Reasons to outsource your prior authorization services for hospitals:

Our team will help in eliminating –

  • Absence of visibility in the Authorization Process
  • Delays in pre-certification
  • Higher employee workload and administrative burdens
  • Lack of patient focus
  • Problems in revenue cycle management

With an extensive understanding of individual Payer requirements, our team completes all your pre-certification functions by ensuring:

  • Accurate Eligibility Verification
  • Quick initiation of the authorization process
  • Diligently following up on the request
  • Obtaining and acknowledging authorization
  • Scheduling the procedure

We further ensure:

  • 100% prior auth request submission on the same day itself
  • 99% accuracy rate
  • Increase in your authorization rate by 1.5 – 2x
  • Assisting you schedule procedures within 48 hours
  • Saving your practice time and money
  • Redeploying your resources to core functions of patient care
  • Reducing cost by up to 80%!

The best part is, all our services are placed at $7 per hour with a full-time resource working only for you, taking care of all your authorization gaps and prior authorization requirements, care plans and more. Sunknowledge not only ensures a faster authorization solution, but also a highly efficient one.

Speak to a Sunknowledge expert right now and transform your flow of revenue without worrying about running short of resources. You are just a call away from seamless prior authorization support!

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