Generally speaking, your staff knows when an authorization is required and they generally procure the authorization at setup. However, many providers incur unnecessary write-offs and extra touch points beyond the initial authorization. Why does this happen? Typically it comes down to a process failure. Authorization gaps are avoidable. A two-pronged process should be in place to maximize your success rate.
First, we have to set ourselves up for success by taking full advantage of our billing systems and technology. This cure starts at intake… when loading an authorization to your billing system, your staff must also load expiration dates (and approved quantities for supply claims). These details can be leveraged to stay ahead of expiring authorizations and excessive fills that are uncollectible.
Second, leverage reporting based on these data elements to consistently procure authorizations before they are due. Monitor expiring authorizations and begin the process of submitting a renewal request at the earliest point permitted by that payer. Generally speaking, this can be done a few weeks before the current authorization expires. Remember to also engage the patient as part of this proactive communication when the renewal requires new medical records or compliance information. When you stay proactive, you eliminate gaps in reimbursement, unnecessary write-offs, unnecessary denials and fruitless appeals.
First, we have to set ourselves up for success by taking full advantage of our billing systems and technology. This cure starts at intake… when loading an authorization to your billing system, your staff must also load expiration dates (and approved quantities for supply claims). These details can be leveraged to stay ahead of expiring authorizations and excessive fills that are uncollectible.
Second, leverage reporting based on these data elements to consistently procure authorizations before they are due. Monitor expiring authorizations and begin the process of submitting a renewal request at the earliest point permitted by that payer. Generally speaking, this can be done a few weeks before the current authorization expires. Remember to also engage the patient as part of this proactive communication when the renewal requires new medical records or compliance information. When you stay proactive, you eliminate gaps in reimbursement, unnecessary write-offs, unnecessary denials and fruitless appeals.
This two-pronged process seems so simple, but often it does not translate into practice because we get tunnel vision. If intake only documents the authorization number and moves on, we are pre-dispositioned to collection failures. Furthermore, we find that many providers misalign the renewal process with incompatible staff. We find that it is much more effective to align this not with intake… but with a “Special Forces” type team that handles “outtake” tasks. Outtake should be a division of intake with a focus on all tasks that perpetuate a revenue stream beyond setup and delivery. The outtake team should target compliance data, renewal CMNs, renewal authorizations and changes in insurance… again from a re-vetting perspective unique to the intake model.
We leave too much on the table when we diagnose cash problems through an AR report… by starting at the very beginning, we can PREVENT billing problems. Join us next Thursday at 2 PM Eastern, when we will host a live event titled “You Had Me at Hello: Good Collections Are Born at Intake.”
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