Getting Your Prior Authorization on Track for Better DME Billing

Prior authorization demands of a medical practice make them vulnerable to administrative malpractices. While it is true that prior authorization was primarily aimed, to prevent patients from being exploited and safeguard their interests from drug abuse, the miscommunication between the provider and the payer ultimately delays a patient from receiving proper treatment effectively.

The average says that a practice spends $ 65,000 a year for PA’s and yet faces almost a 40 percent denial due the complexities in policies of approval. It is pertinent to take the assistance of a billing company that understands modern practice management priorities. A streamlined electronic prior authorization platform that integrates well with the EMR should be the idea.

Sun Knowledge has the experience in DME Practice Management

One of the vital reasons, to consider Sun Knowledge as your next partner for prior auth services, will always be our understanding of the claims adjudication mandates of the industry better than any other. We have the experience of working in DME billing, proficient across all the major billing platforms and provide you a streamlined eligibility verification and authorization support.

♦ We believe that using state of the art technology that reduces time and error in auth submission will be crucial. Our proprietary platform “prior auth online” has been developed to meet your everyday auth requirements.

♦ We will combine expert resources that will be working for a more proactive prior authorization support and lay down the right checks and balances.
We are delivering our prior authorization services at just $5 per auth at the moment. We will provide all the necessary assistance with
Gathering of information

♦ Patient information: Name, DOB, Insurance
♦ Ordering provider’s information: Name, NPI, TaxID, Address, Phone#
♦ Check whether ordering physician is PECOS certified
♦ Place of Service
♦ Service codes
♦ Diagnosis codes
♦ Units for each service code

Contacting the payer

♦ Determine the process for prior authorization request submission, i.e. portal, fax, phone etc.
♦ Contact for UM/Prior Authorization department
♦ Fax to send medical notes (if required)
♦ Expected turn-around time
♦ Limitations/exceptions (if any)

Our predetermination, initiation and follow up activities include

♦ Check to determine whether patient is eligible based on payer requirements for Prior Authorization
♦ Initiate prior authorization request as per payers’ guidelines / protocols
♦ Follow-up with payer via outbound calls, portal etc. to check authorization status
♦ Follow-up with ordering physicians’ offices for medical notes, therapy charts, other documents etc. (if required)
♦ Provide additional documents/information if requested by the payer
Update Authorization outcome in the PM/billing system. The information will include:

♦ Authorization
♦ Date range
♦ Units

Partner with Sun Knowledge for receiving an end to end practice management/ revenue cycle management support in DME billing. We provide collections, AR recovery of denial management services of superior standards. We have top class references from leading industry peers on how we have reduced their costs of billing by 70% and increased collections by 97%.

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