Radiology Prior Authorization Services

In the intricate realm of modern healthcare, radiology lab practices play a crucial role in diagnostic procedures and patient care. However, the complexities of prior authorization (PA) can pose significant challenges, leading to claim denials and operational inefficiencies. At Sunknowledge, we offer a game-changing solution with our Radiology Prior Authorization Services, freeing imaging centers from the burdensome task of obtaining pre-authorizations and ensuring timely procedures for your patients.

Managing the Prior Authorization Burden in Radiology

Failing to secure proper prior authorization stands as a primary culprit for claim denials across medical specialties, and radiology is no exception. Whether you are an imaging specialist or a referring physician, obtaining prior authorization is pivotal. It ensures that patients can undergo necessary procedures promptly while also reducing the overall turn-around-time (TAT). Dedicated Radiology prior authorization support and services have emerged as a lifeline for practices, alleviating the need for extensive administrative efforts in obtaining pre-authorizations and ensuring compliance with insurer requirements.

Before rendering services, radiologists must rigorously verify the acquisition of prior approval from insurance companies (payers). Without the required authorization, payments for procedures performed are at a risk of denial. Several radiology exams necessitate pre-authorization, including Bone Mineral Density exams, CT scans, MRI/MRA, Nuclear cardiology, PET scans, and Stress Echo Cardiograms. In fact,

  • 90% of all tests performed by imaging centers and radiology labs require prior authorization.
  • A 2023 survey by the American College of Radiology found that 95% of radiologists believe prior authorization delays patient care. For 87% of them, prior authorization negatively impacts their ability to manage practices efficiently.

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The Crucial Role of Front Office Staff in the Authorization Process

The process for authorization initiation commences at the time of patient registration for an appointment. Front office staff becomes integral in gathering comprehensive information about the patient’s condition and the reasons for the exam. Thorough details are crucial, as communication with the referring physician’s office may be necessary.

It is imperative to verify that imaging orders are not only appropriate but complete. In certain cases, the referring office may have already obtained authorization from the insurance company. Virtual office assistant services can help facilitate a clear line of communication between payers, providers, physicians and members (patients) at significantly reduced costs.

Accurate reporting of specific procedure and diagnosis codes in the claim is as crucial as obtaining prior approval. Recent CPT coding updates in radiology, such as the addition and deletion of codes, underscore the importance of coding accuracy for proper claims processing.

Every step in the revenue cycle management process is connected from patient entry to medical coding, claim collections and accounts receivable management. Optimizing these processes through support from dedicated service providers in prior authorization or medical billing and coding has an instant reduction in costs, TAT and denied claims.

Ensuring Prior Authorization Accuracy and Compliance

Once obtained, the radiology practice must meticulously verify that the approval aligns with the intended exam, including the date of service, as authorizations can have expiration dates. Any delay in obtaining authorization necessitates rescheduling appointments to avert denial. Robust appointment scheduling services become imperative, ensuring patient satisfaction and averting payment delays.

Communication is key to maintaining accuracy throughout the process. Any changes to the ordered diagnostic/imaging test must be promptly communicated to the insurance company, aligning procedure codes on the claim form with the payer’s authorization records. Continuous monitoring of the prior authorization process is essential to ensure timely and accurate claims payment.

Radiology Prior Authorization: Expert Insights and Regulatory Guidelines

As one of the leading radiology prior authorization companies, we have extensive knowledge of payer rules, clinical documentation and establishing medical necessity.  We specialize in getting timely approvals for costly or boutique medications and even supplies that may be considered cosmetic at first glance like Botox.

When it comes to Prior Authorization for Radiology Centers and imaging laboratories, there are specific guidelines, such as:

  • Only one authorization request is needed for Abd/Pelvis CTA & Lower Extremity CTA.
  • Separate authorizations are required for Abdomen/Pelvis MRA & Lower Extremity MRA Runoff Requests.
  • An authorization for MRI in addition to MRA is not required, as a request for MR Angiography includes standard MRI imaging.
  • Single authorizations cover imaging of entire maxillofacial areas or specific regions like the Orbit, Face, Sinuses, and Neck.

Outsourcing to Radiology Prior Authorization Services

The time-consuming nature of the pre-authorization process means that radiology practices can enhance efficiency by outsourcing this task. Professional medical billing companies, equipped with the latest knowledge of changing insurance authorization requirements, offer a practical solution. Skilled Prior Authorization Coordinators in these companies streamline the process, coordinating efficiently with insurers and ensuring comprehensive documentation. This means that in-house staff is not bogged down in hour-long telephone conversations with insurance help desks or dealing with their IVR system.

Benefits of outsourcing radiology prior authorization:

  • Reduced Administrative Burden
  • Improved Financial Performance
  • Enhanced Patient Care

Additional Advantages:

  • Scalability and flexibility
  • Access to compliance experts
  • Leverage advanced tools

Dedicated Support in Prior Authorization for Radiology Centers

In partnering with Sunknowledge for Radiology Prior Authorization Services, you’re not just outsourcing a process; you’re embarking on a journey where efficiency, compliance, and patient care converge seamlessly. Forget long wait time for approval on tests like CT (computerized axial tomography), MRI (magnetic resonance imaging), MRA (magnetic resonance angiography) or PET (positron emission tomography) scan.

Here are some benefits of our services which our partner practices appreciate:

  • 24 hrs. (max.) for regular PA requests
  • 15 mins. (max.) for STAT PA requests
  • Up to 80% reduction in collection cost
  • Full HIPAA compliant procedures
  • Custom reporting
  • Liability insurance coverage of $3M
  • No binding contracts
  • Dedicated radiology pre-authorization specialists
  • Strong payer relations
  • Industry best cost per full-time equivalent (FTE)
  • Trustworthy references and client testimonials

Schedule a no-obligation, free consultation with our experts today, and let us optimize prior authorization for your radiology practice, now!

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