Prior Authorization for Home Health Services

The political, social and economic growth of any country depends on the healthy population engaged in productive activities. The population needs to be aware of things that are detrimental to their health and what they should do to combat this. This includes but is not limited to, healthy activities, taking medications regularly, having first-aid practice with the right supplies and latest details on hand, and notifying a doctor as soon as anything appears wrong health-wise. Over the past several years, the growing shortage of doctors has made the US physician workforce more difficult for patients. At the same time, healthcare providers face increasing costs and declining revenues. To make it easy for the payers and providers, the third-party administrators have emerged as the perfect mediator between these two groups that help in reducing billing costs and drives remarkable revenue growth.

The home healthcare service is a wide range of healthcare benefits that can be served at home with immediate importance. Medicare Parts A and B cover the home health services, and are usually coordinated by a licensed doctor. Outsourcing the tedious process of prior authorization of home health services are done to help maintain consistent and timely cash flow, the billing, collections, coding, and accounts receivable.

“Requiring prior approval for every prospective home health recipient in a state for the provision of critically important services that help keep people in their homes rather than institutions, often when they are at their most medically vulnerable, will effectively delay and deny home health coverage for countless Medicare beneficiaries,” says Center for Medicare Advocacy, an organization that helps ensure seniors have access to coverage and treatment. Prior authorization of home healthcare imposes a requirement that prevents a patient from receiving home health services after the physician orders home healthcare, unless and until an intermediary has reviewed and approved the order.

Outsourcing prior authorization of home health services is a rapidly growing trend as leading healthcare companies in the US have started realizing the many benefits of employing dedicated, third-party personnel for managing the revenue cycle. Substantial cost-cutting, better cost-effectiveness and an overall increase in revenue are some of the reasons to outsource prior authorization of home health services. Home health agencies can benefit immensely from the updated knowledge of dedicated pre-auth professionals about the latest mandates from various insurance companies.


Sunknowledge Services Inc.
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