Prior authorization

While managing Revenue Cycle Management (RCM) for the Healthcare industry, Prior Authorization, a crucial back-end process, involves obtaining approval from insurance providers before certain medical services or treatments. Insurance prior authorization ensures that healthcare services meet specific criteria outlined in initial authorization Requirements. Healthcare providers often use Pre-authorization (PA) Forms to submit comprehensive information, adhering to prior authorization Guidelines. This procedure helps streamline Electronic Prior Authorization (EPA), facilitating quicker and more efficient approval. By navigating the intricacies of previous authorization, healthcare professionals ensure optimal patient care while aligning with insurance protocol.

Book Your Free Trial

Enter your valid name
Enter your contact number
Please enter a valid email ID
Choose number of FTE Required
Choose a service category
Enter a valid message with minimum of 5 characters
Captcha Required!

What is the basis for prior auth or pre-authorization process in medical billing?

Transcription Services Image
  • From the back-end, the Medical Billing team facilitates the details of the pre-approval process, managing every step from the initial authorization request to the completion of the approval workflow. Improve your Revenue Cycle Management (RCM) with a streamlined pre-authorization process to ensure a hassle-free healthcare experience. The process highlights accuracy when determining medical necessity. By entrusting your pre-authorization needs to a back office team, you benefit from a organized framework that accelerates the approval process and minimizes delays and denials. Experience a smoother and more efficient revenue cycle with a dedicated focus on the pre-authorization process, modified to meet the unique needs of your healthcare practice.

Why is prior authorization, an important tool in RCM cost control?

  • At RND Softech, a key objective in the integration of prior authorization within the healthcare sector is cost management. By requiring approval before certain medical services or treatments are provided, insurance payers can carefully evaluate the necessity of the proposed care. This helps prevent. Unnecessary expenses for the payer and the patient contribute to overall cost containment within the healthcare system.

    Prevention of unnecessary procedures:

    Prior authorization serves as a safeguard against unnecessary medical procedures. Only some medical interventions are equally effective or appropriate for some patients. The prior authorization process ensures that healthcare providers and patients carefully consider the medical necessity of a proposed treatment, reducing the likelihood of unnecessary and potentially risky procedures.

    Alignment with medical guidelines:

    Prior authorization ensures that the proposed treatments align with established medical guidelines and standards of care. This alignment is crucial for maintaining the quality and efficiency of healthcare services. By sticking to recognized medical guidelines, Prior authorization helps guarantee that patients receive evidence-based and medically justified treatments.

    Compliance with insurance payer policies:

    Each insurance payer has specific policies and guidelines regarding covered services, medications, and treatments. Prior authorization ensures compliance with these policies, preventing misunderstandings and disputes between healthcare providers and payers. It promotes transparency and clarity in the utilization of healthcare services within the patient's insurance plan framework.

    Resource allocation:

    Prior authorization helps in efficient resource allocation within the healthcare system. By carefully evaluating and approving only medically necessary treatments, resources such as medical personnel, facilities and equipment can be directed to where they are most needed. This allocation supports a more effective and sustainable healthcare delivery model.

    Preventing fraud and abuse:

    The prior Authorization process acts as prevention against fraud and abuse within the healthcare system. Requiring documentation and justification for certain services helps identify and prevent situations where services may be provided for reasons other than the patient's health, such as financial gain.

Why could RND Softech be your trusted back-end support partner for prior authorizations?

  • RND Softech's dedicated team ensures a seamless process by staying to precise authorization criteria and providing clear documentation guidelines. Organize your revenue cycle management (RCM) with our expert handling of prior authorization requirements. We specialize in accelerating the prior approval process, ensuring a swift and efficient experience from procedure-specific authorization, meeting all approval basics.
  • Trust us to manage prior authorization requirements, utilizing advanced tools to expedite approvals and minimize delays. By choosing RND Softech's services, you benefit from an expert approach that ensures compliance with all criteria and basics, contributing to a streamlined and efficient revenue cycle management for your healthcare practice.
  • Prior authorization operated with a flexible approach within our medical billing verticals at RND Softech that serves not only to control costs but also to enhance the quality, appropriateness, and efficiency of healthcare revenue cycle management services. It aligns with established medical guidelines, ensures compliance with insurance payer policies and contributes to the overall effectiveness of the healthcare revenue cycle system.

Empower Your Revenue Cycle with RND Softech - Propel Your Business Forward with a 30 days free trial!

Frequently Asked Questions

The business world is being flattened by economics, technology, demographics and regulations. To win in this flattening world, companies must transform their way of working to seek and convert new opportunities wherever those opportunities may be. This means acquiring the ability to disaggregate your operations, people and resources across time zones, geographies, cultures and sourcing and delivering.

1. Why should I outsource to RND Softech?

By outsourcing to RND Softech, you will experience an immediate reduction of up to 60% in your manpower costs. We provide staff to take care of your front end and backend operations. This will enable you to focus on growing your business without having to worry about increasing operational costs, employee attrition, etc.

2. What are the services you offer?

We offer entire Revenue Cycle Management - a few of them being, data entry, insurance verification, authorization, Doctor's office follow-up, intake, order processing, billing, denial management, payment posting, inbound and outbound patient calling, 24 x 7 customer support, scheduling processes etc.

3. Do you have experience of working in the healthcare industry?

Yes, we have more than 22 years of experience working in the US healthcare industry. We have been providing medical transcription services to hospitals across the United States since 1999 and DME/Home care back office services since 2012.

4. What is your on-boarding period for a new employee/customer?

Anywhere between 1 to 14 days.

5. What would be the FTE's working hours?

The FTE would work the US working hours, in the time zone of your choice.

6. Is the contract obligatory? Is there a minimum or maximum contract period?

Yes, but it is a no-obligations contract and is non-binding and there is no minimum contract period. The contract simply states that the two companies are entering into a partnership for the providing and receiving services. You can terminate the contract if you are not satisfied with the services. A notice period of 1 month is appreciated but not mandatory.

7. Are you HIPAA compliant?

Yes, we are certified for HIPAA and Information Security Management Systems.

8. Is there any contract to be signed before getting started?

No, the contract is not obligatory and there is no minimum contract period. The contract simply states that the two companies are entering into a partnership for the providing and receiving services. You can terminate the contract if you are not satisfied with the services. A notice period of 1 month is appreciated but not mandatory.

9. Do you follow FTE based billing or percentage of revenue generated billing?

We follow an FTE-based billing. One FTE (full time employee) works 8 hours a day, 5 days a week - a total of 40 hours a week.

10. How will I be billed?

You will be sent an invoice each month mentioning the number of FTEs agreed upon and the services provided.

11. How can I make payments?

You can make payments through PayPal using your credit card or make a wire transfer.

12. Are the FTEs your own employees or do you subcontract to other smaller companies?

All our FTEs are employees of RND Softech and are dedicated to each client, the agent will not be shared with other clients

13. Where are you located?

We are located in Southern part of India.

14. Do you follow US holidays or local?

Yes, We follow US holidays.

15. Are You Certified?

Yes we are one ISO 9001, ISO 27001, HIPPA and SOC2 Certificates.

Our Reviews

dog
dog
dog

Certifications

RND Softech, is a 25 year old Pioneer Off-shore BPO staffing partner servicing the US , UK, Canada & Australian markets across 15+ Back office support domains.

Let us know Who you are!