HME Prior Authorization: All You Need to Know

HME Prior Authorization: All You Need to Know

The AMA (American Medical Association) due to the frustrating and time-consuming prior authorization process has surveyed 1000 physicians. In the survey, the process of prior authorization has reported being time-consuming, creating a negative impact on patients with an increased administrative load.

Prior Authorization as Time-Consuming Process:
  • An average wait of one full business day for a prior-authorization approval is experienced as reported by 65%
  • 26% reported waiting for the approval for a minimum of 3 business days
  • And a wait of 7 % of physician has reported for more than five business days.
Negative Impact on Patient mental and physical health:
  • 28% reported that the prior authorization has been noted responsible for a serious adverse event
  • Increased risk for mortality ranging from 1.2% to 3.2% for each week for health risk diseases due to prior authorization delay
  • More than 9 in 10 respondents reported the process of Prior Authorization had somewhat negative clinical impact.
  • 75 % believe that the time consuming and frustrating Prior Authorization process can lead to discontinuing patient treatment.
Increased The Administrative Burden
  • 86% of physicians felt a higher level of stress for the complex prior authorization process
  • With years, increased in prior authorization rate is seen as reported by 88%
  • An average of 31 prior Authorization process is seen per week by the physician
  • Up to 36 % reported that the complex process requires dedicated staffs exclusively for the prior authorization process

With the complex prior authorization process healthcare providers today needs operational extension support that can ease, all the complex prior authorization process effectively with a faster solution.

PriorAuth Online is the solution to all authorization problems starting from DME, specialties pharmacies, orthotics and prosthetics, HME prior authorization and all other specialties too.

PriorAuth Online powered by Sunknowledge Services Inc is an authorization platform that enables healthcare providers and payers leverage all prior authorization benefits like monitoring, submission and a complete prior authorization process with a 100% prior authorization submission on the same day.

For a Successful HME Prior Authorization Process Our Experts Ensure:

Collection of Complete Data-

  • Name, date of birth, insurance details of Patient/subscriber
  • Servicing provider information details (LAB)
  • Ordering provider information details
  • Place of Service
  • Procedure / CPT codes
  • Diagnosis codes
  • The estimated date range for Pre-authorization

Contacting The Payer and Working Out Payer Related Activity

  • Determine the process for prior authorization request submission, i.e. portal, fax, phone, etc.
  • Contact for UM/Pre-Authorization department
  • Fax to send medical notes
  • Expected turn-around time
  • Limitations/exceptions (if any)

Initiation and Follow up Activities

  • Check to determine whether the patient is eligible based on payers requirement for PA
  • Initiate prior authorization as per payers’ guideline/protocol
  • Follow-up with the payer to check authorization status via outbound calls, portal etc
  • Follow-up with ordering physicians’ offices for medical notes, documents and therapy chart if required
  • Providing additional documents/information if requested by the payer

Updating The Authorization Outcome in the PM/Billing System

  • Authorization
  • Date range
  • Units
Apart from providing successful prior authorization process we also cater to standalone /end to end billing services for:
  • Rx Order Entry
  • Patient demographics & insurance entry
  • Product Code/Rx & Dx Entry
  • Eligibility verification/Authorization
  • Collection of complete Rx
  • Collection of documents for Auth approval
  • Submission
  • Rejection/denial management
  • A/R Follow-up

Increase your prior authorization rate by 1.5-2x, we also ensure 80% operational cost reduction and 97% highest collection rate. With complete operational transparency, robust reporting and a no-cost dedicated account manager, we provide a complete tailored customized prior authorization solution for all our clients enhancing on their revenue generation as well.

For more information on how our experts can help you with streamline operation and financial upliftment, get in touch with PriorAuth Online experts.

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