When auditing a healthcare organization, one of the greatest contributors to lost revenue is failure to obtain a referral or authorization prior to performing a procedure. Not all services and procedures require a referral or pre-authorization, but if a referral or pre-authorization is required and is not obtained, reimbursement for the procedure is put at risk. While some insurance carriers may allow a retro authorization or referral, most do not.
As daily tasks begin to build up, this part of the revenue cycle process is one that is often missed, and is the most costly. Utilizing our referral and pre-authorization services confirms that the patient is approved for the planned service or procedure prior to arrival, ensuring that the first stage of the revenue cycle is completed accurately. Doing so sets the rest of the claims process up for success.