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Time to Reorganize your Prior Authorization for DME

Posted by healthcaresbilling on June 12, 2019 at 1:00 PM

Even with years of prior authorization, the procedure is still frustrating and takes away a lot of time from most of the physicians; clinical and administrative staffs. This is why eliminating the hectic procedure is all that everyone is looking for. However, the finding has shown prior authorization initiatives can be beneficial. It is not only beneficial for payers who needed to limit healthcare spending but all providers as it reassured complete reimbursement for DME services.

The finding of the new government accountability office (GAO) report stated from 2012 to 2017 that, by controlling unnecessary spending the CMS prior authorization program for DME and mobility device has created $1.1 to $1.9 billion in Medicare saving.

As we know the process of DME prior authorization is not eliminating any soon, this is why finding the perfect operational extension for a faster and effective prior authorization is very essential. Even the perfect operational extension not only helps in providing stress-free prior authorization for DME process but also increase the approval rate for also other specialties like radiology, genomic lab, orthotics and prosthetics etc within a very cost effective method.

Keys for Perfect Operational Extension:

Compliance - as these outsourcing organizations requires every patient’s information starting from their name, addresses to insurance no etc for the prior authorization process and misleading the information can cause a hazardous outcome. This is why finding a secure operational extension becomes very important

Productivity & collection rate - one should always look for an outsourcing option that offers the highest productive metric and collection rate as these are key elements for ROI.

Robust reporting - healthcare provider should look for an organization that provides complete operational transparency with proper workflow reporting. This will help healthcare organization have a clear picture of the work process as well as the area where maximum attention needed.

Cost effective - one of the main reason for outsourcing. It is seen that in-house end up costing more with an unsatisfactory result. Whereas outsourcing not only proved to be cost-effective but also gives a satisfactory outcome along with a report of the progress details.


Why Sunknowledge?

Sunknowledge Service Inc a 100% HIPAA Compliant decades-old medical billing organization also specialized in Prior authorization process ‘PriorAuth Online’. PriorAuth Online guarantee operational transparency along with an increase in your prior authorization rate by 1.5-2x. With years of working excellence, we provide 100% prior authorization submission on the same day.

With our service charge as low as $7 per hour we have the highest productive metric insuring 80% instant reduction in your operational cost. Our 99.9% accuracy rate and 97% collection rate help us achieving and maintaining our more than 100 clientele including Medtronic. In fact, our no-cost dedicated account manager with robust reporting according to client’s protocol, daily/weekly/monthly and many more benefits have earned us many industries reference. We also specialize in providing end to end CPAP compliance support with an excellent record of increasing the compliance rate, from 40% to 80% helping you achieve a better collection rate.

Services we offer for DME prior authorization:

  • Gather vital information on medical procedure, patient, and provider
  • Verify and validate prior auth request with effective payer side communication
  • Check the patient’s eligibility
  • Initiate the auth request based on the payer mandates
  • checking the auth status
  • Collating relevant documents from the ordering physicians/follow up
  • Providing additional information if any
  • update the auth income in the PM/Billing system

We not provide prior authorization for DME but also to 27 other specialties. We also specialized in pre-billing activities like Rx, patient’s demographic, insurance and other necessary medical details and Dx order entry, eligibility verification, a complete collection of required documents, submission, order confirmation and delivery. Even claims management, payment posting along with account receivable follow up is also our expert areas.

So get in touch with us, so that our experts can help you with an effective prior authorization solution for DME and increase your cash flow.

Categories: DME

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