As the linchpin of modern diagnostic medicine, Imaging Centers such as radiology labs play a key-role within the healthcare system. The burden of pre-approvals however, has long convinced these important providers to take help from professional imaging centers prior authorization services.
Practices are often forced to wait for approval on critical radiology exams like CT (computerized axial tomography), MRI (magnetic resonance imaging), MRA (magnetic resonance angiography) or PET (positron emission tomography) scan. Failing to obtain prior authorization in time can lead to unpleasant surprises afterwards, for both providers and patients. In many cases, coverage can get entirely denied on the pretext of non-existent prior auth. To make matters worse, after the service has been provided and the claim form submitted, uncollected payments on bills remain unpaid for months before getting written off.
As one of the top prior authorization companies for imaging services, we have consistently delivered a fast and denial-free prior authorization for imaging centers. Before we explore how we deliver prior authorization for imaging centers practices, let us delve into the challenges that practices face.
Prior Authorization for Imaging Centers: Current Challenges
- Imaging centers spend an average of 12 hours per week on prior authorization tasks.
- Up to 20% of claims submitted by Imaging Centers are denied due to health insurance approval errors.
Source: Outsource Strategies International)
- Delays and denials due to inadequate prior authorization led to an average revenue loss of 5 – 10% for imaging centers.
Source: Healthcare Financial Management Association)
Doctors rely on Imaging Centers for critical diagnostic insights, but the entire process is burdened with prior-approval related delays. Such delays affect not only patientcare, but also providers and their practices. Abandoning treatment due to lengthy delays in getting prior authorization is common. Over time, such snags have whittled down the trust of patients in the health system.
In a perfect system, when an Oncologist orders an urgent scan for a patient, the request would get transcribed, processed, and sent to the Payer the same day. This would ensure that the patient can receive the best care possible, as soon as possible. However, PA denials and the backlog of preapproval requests in Imaging Centers prove too much for their staff to handle.
It is not feasible for small and medium practices to seek an automated process which requires substantial investment. On the other hand, it would not be practical even for large practices to hire an entire suite of trained staff-members simply to handle prior approval requests.
This conundrum has led most practices to opt for third-party Imaging Centers Prior Authorization Services which get them dedicated support and excellent payer relations, resulting from a smooth pre-certification process.
Most Common Cardiology Procedures with Low Prior Authorization Approval Rates
According to a study published in the Journal of the American College of Cardiology, the most common cardiology procedures with low prior authorization approval rates are:
- Transcatheter aortic valve replacement (TAVR)
- Percutaneous coronary intervention (PCI)
- Implantable cardioverter defibrillator (ICD)
- Heart transplantation
- Heart valve surgery
- Carotid artery stenting
- Coronary artery bypass graft (CABG)
- Electrophysiology (EP) procedures
Factors Responsible for Denial of Prior Authorization Requests for Cardiology Procedures
The pressure of increasing prior auth requirements is making the current economic and operational challenges worse for healthcare organizations. To ease these pressures and effectively deal with the problem of prior-authorization denial for cardiology procedures, it is crucial to understand the most common factors that insurers cite to deny approval.
- Lack of medical necessity.
- Experimental or investigational nature of the procedure.
- Patient’s conditions don’t meet criteria for the procedure.
- Patient’s health plan does not cover the procedure.
- Incorrect submission of prior auth requests.
Why Outsource to Imaging Centers Prior Authorization Services?
- A 2023 survey by MGMA found that 85% of Imaging Centers outsource at least some of their prior authorization tasks.
- A study by AAPC revealed that imaging centers that outsource Preauthorization
experience a 30% reduction in claim denials.
- A recent poll by Radiology Business showed that 70% of administrators believe outsourcing radiology prior authorizations services improves staff morale and productivity.
(Source: Radiology Business)
Outsourcing Imaging Centers Prior Authorization takes care of:
- Prior authorization burden – Innovative tools and automation, along with a large pool of trained workforce, clear out backlogs and denied requests, and free up staff to focus on patient care.
- Preventing claim denials – Dealing with claim denials requires deep expertise in every step of Imaging Centers revenue cycle management. However, the key step is denial prevention and getting an optimized PA process causes less trouble and follow ups.
- Revenue impact – Outsourcing to experts expedites the PA process which leads to faster approvals and an overall happier patient outcome. Practices and laboratories can deal with heavier workload in a shorter time which quickly increases turnover.
With Radiology Prior Authorizations Services, an Oncologist can order a test for a patient in Chemotherapy and the Radiology Laboratory which might process the preauthorization can expect a timely clearance from the health insurance company. This enhanced speed and accuracy can play an important part in preventing denials and help elevate the overall imaging center’s revenue cycle management process.
Complete support with Prior Authorization for Imaging Centers
As a leading prior-authorization service provider, Sunknowledge Services Inc. is among the top Imaging Centers Prior Authorization Company with extensive experience and excellent payer relations. From Imaging Centers Billing and Coding Services to our Radiology Accounts Receivable Services, we address everything that your practice needs.
The advantages of partnering with us for your pre-approval needs are:
- Request initiation time is 24 hrs. (max.) for regular PA requests and 15 mins. (max.) for STAT PA requests
- Up to 80% reduction in collection cost
- Liability insurance coverage of $3M, ensuring excellent guard against errors of omission and commission
- No binding contracts, with an easy 30-day exit clause
- Full HIPAA compliant procedures
- Custom reporting as per client needs
We tailor our processes to meet the exact needs of our partners. Practices that we work with appreciate the free dedicated account managers and regular communication from our teams.
Speak to our experts today and get access to our large pool of trained experts who have among the highest productivity metrics across the industry at the lowest cost!
Sign up for the best support in Prior Authorization for your imaging center practice.