About our Prior Authorization Services

Healthcare Authorization Services – Prior authorization is one of the trending terms of the healthcare industry in recent times. This blog gives you a clear picture of previous authorization, why it is essential for RCM, and how to handle PA most effectively in your practice.

What is Prior Authorization in Healthcare?

Even before insurance companies agree to pay for medications or medical equipment, medical providers require a sign of a patient receiving a specific treatment (PA).

Maybe you still have questions such as who uses this PA? To what end do they use it? Doctors do not operate this Prior authorization, health insurance companies to verify that a specific treatment or type of treatment is medically necessary before prescribed.

Prior Authorization in RCM

In revenue cycle management (RCM), prior authorization is essential as payers need to confirm whether a particular pharmaceutical or procedure is approved. Suppose the insurance company does not support some treatments or medical devices. In that case, healthcare providers should wait until approval is obtained, or they should contact insurers for permission and then take the required steps.

A pulmonary expert, for example, may recommend the chest CT scan for a patient, but a heart specialist for the same patient may have already prescribed the same scan before two weeks. Why do you have to wait until your treatments have been approved? Since non-approval after treatment leads to enormous costs for either the patient or the provider of medical services. That not only disturbs RCM function but affects patient care because of the omission of the PA process.

How we make pre-authorization more efficient for you.

Accurate Documentation to Avoid Denials

Because most healthcare providers take most of their precious time, the long prior approval process is not preferred. But the use of PA shortcuts only leads to negative results. It is better to do so for the first time to avoid this type of problem.

Today, there are many new insurance plans and new drugs within PA, and medical professionals can still find it difficult to take further steps. Prior authorization has, therefore, now become an approach that saves money. Many suppliers have also begun moving to electronic PA to manage documents better and save time.

Approved Pre-authorization makes the documentation procedure easy

Some insurance firms have specific treatments and prescriptions approved in advance.  This will make it easier to precede the documentation process, resulting in an effective RCM. Sometimes complaints about irrelevant billing costs are received by both the patient and the insurance company in the process of approved preauthorization. The insurance company is not guaranteed and needs to cover 100% of costs.

Therefore, it is recommended that the correct information be provided regarding the fixed amount paid on your visit to a doctor, the initial payment before the pitch of an insurance plan, and the percentage of the patient’s health visit cost.

Patient Role in The Prior Authorization Process

It’s not the health providers and payors who are using the PA process. In the preauthorization process, the patient also plays a key role. Why do they have to share information and understand the criteria for inclusion and exclusion of the payer?

The medical providers should ensure that the patient data are accurately collected before initiating the PA process. That includes full medical history, previous treatment details, conditions, symptoms, diagnosis, and detailed provider notes.

The insurers are not covered for specific concerns and non-emergency therapies, and they are not eligible for PA. Since each insurance company has its own rules for prior authorization, each healthcare provider is responsible, and the patient must check the information in advance.

Use Emerging Technology to Make PA Better

With the start of a profound technological change in the health industry, prior authorization also becomes technological progress. Today, many software applications with access to electronic health records are developed for PA (EHR). This kind of superpower software’s advanced capabilities is to access and sync patient medical records, reduce PA errors, and reduce time and cost authorization processes.

The next big thing to notice is an advanced Electronic Prior Authorization – it is easy to recognize the existing CPT code or HCPCS code. To determine what is needed, gather data from the visit notes, and pre-approval to include diagnostic procedures, the electronic PA matches those codes to the insurance rules. It is therefore recommended that the latest solutions for improved PA be updated and implemented.

Patient health records and PA secure

The security of privacy and information should be your priority when managing patient health records and the Electronic Health Record (EHR) prior authorization platform. All of this should be safeguarded, such as password control, system access authorization, access controls, WIFI, and physical controls.

Medical Billing, Coding, and Auditing Services to help your practice focus on what matters the most.

Aqkode Healthcare Solutions has fine-tuned the entire Revenue Cycle Management process.
Our Revenue Cycle Management Services take care of everything from Patient Pre-Authorization / Pre-Registration, Eligibility Verification & Benefits Authorization, Medical Coding, Charge & Posting, Referrals, Payment Posting & Remittance Processing, and A.R. follow-ups.
Medical Billing is the process of converting a patient visit to a health insurance claims to receive payment from a health insurance company for services rendered by a physician. A knowledgeable medical billing company can optimize revenue for the practice. Contact us today to learn more!
Aqkode Healthcare Solutions Claims Management handles everything from submitting patient info, scan and correct billing info, submit and file the claim, provide follow-ups, provide you with info about the claim, and process  denied claims and re-adjudicate them.
We manage Accounts Receivables Follow-up‘s and work to reduce the number of days to collect for services rendered and is a crucial piece of medical billing. Understanding payer processing times, payment policies and doc requirements are some of the ways how we decrease AR, increase revenue and reduce stress.
The first step, collect patient and insurance info. Our Benefits Authorization process gets medical services authorized (pre-authorization or prior authorization) from the insurance payers. Without an authorization, the insurance payer is free to refuse the payment. Give us a call today to learn more!
Aqkode Healthcare Solutions understand the importance of accurate charge entry services and also know how errors in this can affect the cash flow adversely. Our team ensures that we deliver error-free services, which help clients to get their payments in a timely manner.
Chart Auditing is key to ensure the proper levels are coded. If you are under coding, you are losing out on the additional reimbursement. If you are upcoding you’re at risk for audits by Insurances, they can take back the difference on future payments. See how we can help today!
Compliance is the most important thing to get right in the medical billing industry. We ensure compliance for all of our clients by doing: Confidentiality Binding, Secure Data, HIPAA Compliance, Multi-level Quality Control, Resource Training and Scaling and Quick Client Process Adaptation.
Medical Credentialing is not DYI project. The consequences of incorrect provider enrollment and credentialing are costly. The provider can be terminated from payer networks, lose hospital admitting privileges, and see dramatic reductions in new patients and revenue.
Aqkode Healthcare Solutions understands that processing eligibility verification for specialist or internal medicine is necessary as it is directly linked to claim denials or payment delays of any healthcare services. Reduce potential hours lost and issues by calling us today!
Need extra support at the front or back of your office? Never keep your patients guessing or waiting. Our front-end virtual office support service is to receive patients call to schedule patients, or transfer call to the right department. Save time and money and Aqkode today!
Aqkode Healthcare Solutions provides IICD, CPT & HCPCS medical coding services to help you increase your reimbursements. Each patient chart is assigned a particular code that helps in the easy access of medical information for insurance purposes. Call now to learn more.
A lot of business is based on referrals within clinics, but what happens when you lose track of where your medical referrals are coming from? We assist whenever a patient may be referred by one office to another, who may be a specialist in the treatment of the patient.
Our payment posting service works after the adjudication of the claim from the payer, the claim will be either paid or denied. If the claim is processed towards payment from payer, then a payment will be issued to the provider (medical office) from the payer (insurance company).
The process of collecting patient information, verifying records and patient scheduling takes time away from your office staff responsibilities. Use your resources towards other important office tasks that have a direct impact on your business and revenue and call us today!

Why Choose Aqkode Healthcare Solutions?

Increased transparency with financial reports

Better Revenue Cycle Management

Reduce operational costs

Process claims faster and more effectively

Eliminate financial and billing errors

Pre-billing review and coding analysis

Generate more revenue with better financial models

Managing inquiries: patients, insurers, and regulatory authorities

AAPC Certified professional billers, coders and M.R.A., E/M chart auditors

Most practices can't match payer technology, sophistication and man-power. We can help.

Taking care of your patients is what you do best. Taking care of your billing is what we do the best.


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  • United States - 1108 Bell Shoals Rd. Brandon, FL 33511
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