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Prior Authorization For Gastroenterology

Gastroenterology clinic focuses on providing outstanding patient care with the most effective Gastroenterology services.  Prior Authorization plays a crucial part in Gastroenterology Billing as most often the medical necessity of the medical procedure is evaluated by the insurance company to ensure payment of the claim. Prior Authorization and Insurance Eligibility Verification Services goes hand in hand when the medical specialty  is Gastroenterology as many insurance companies have varied rules and policies which is mostly tied to the final reimbursement of the claim. Read below to understand Prior Authorization in Gastroenterology and the process involved:

Prior Authorization Requisition Process and Timeline:

  • Gastroenterology often requires the determination of medical necessity and timely authorization can reduce denials and increase revenue.
  • Best practice would be to obtain authorization 15 days prior to the appointment date to   avoid rescheduling or canceling the patient appointment for lack of authorization from insurance company.
  • Medical Billing and Coding team have to note that majority of insurances have 15-day timeframes to process & approve prior authorization. Abiding by this timeline will benefit all parties involved such as the patient, physician and also the billing process.
  • For EGD procedures patient should be in medication at least 90 days before having the procedure this protocol in fact can cause delays and rejections in authorization approval.
  • Upon receiving authorization approval, e-care team will update the Authorization number in the software with a valid date along with any deductible remaining and copay to collect.
  • Diagnosis Code plays a major role in authorization requirements, therefore having quality coding is mandatory.

Prior Authorization Process Payer Specification:

  • Authorization requirements always depend on insurance type and patient plans.
  • Authorization requests for EGD, Colonoscopy, & sigmoidoscopy are initiated at the Ambulatory surgical center setting and outpatient setting as applicable
  • There are lists of procedures for EGD and Colon but some insurance will not accept multiple codes in the authorization request, as only one procedure can be requested as per the insurance guidelines. In such case, it is advisable to confirm with the insurance company on the possibilities to change the procedure with same authorization number after the service has been performed.
  • Most insurance do not require prior authorization for Colonoscopy screening except for  diagnostic service which always depends on the patient’s health and diagnosis.
  • Medicare and Medicare supplements do not require authorization when service is done in ASC and outpatient settings. However, authorization requests are submitted for Medicare HMO, advantage, and replacement plans.
  • In case the authorization for EGD and Colon is denied due to not medically necessary, a peer-to-peer review with the doctor and nurse reviewer can be scheduled and processed accordingly.
  • Submission of an appeal or reconsideration for authorization denial with documents that support the procedure is possible in most cases.

To know more about Gastroenterology Prior Authorization process and for experienced partner reach out to e-care at 1-813-666-0028 or log on to Prior Authorization Process | e-care India (ecareindia.com)

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How To Make Your Insurance Eligibility Verification Process More Efficient?

Insurance Eligibility Verification

Insurance eligibility verification is the initial and most significant step in the revenue cycle management process Without the eligibility verification process, it’s difficult to communicate with payers and determine the payer responsibilities. These difficulties can increase the number of errors during the claims submissions and also increase the average A/R days & lowers the business revenue. Let us discuss how to process insurance eligibility verification more efficiently.

Insurance Eligibility Verification 

Insurance eligibility verification is the process of checking the patient’s insurance coverage status, eligibility status, etc. Here listed Below is the checklist of information to be verified for a smooth and productive billing of each claim. Type of Medicare coverage

  • Coverage dates
  • Patient demographics
  • Benefit options – including patient responsibilities for co-pay, co-insurance & deductibles
  • Individual plan deductible and deductible remaining
  • Family plan deductible and deductible remaining
  • Referrals and pre-authorizations
  • Claims mailing address
  • Lifetime maximum
  • Address for claims submission
  • In-network or out-of-network status
  • Durable medical equipment coverage

Without verifying this information, healthcare services may be wrecked. Eligibility verification is of paramount importance as any deficiency may lead to claim denials and account receivables delays etc. The major reason for claims denials and delays is that insurance eligibility verification is not done accurately.

Optimize Insurance Eligibility Verification Process

Here are some of the  techniques that can be followed to make the insurance verification process work effortlessly:

Check the patient’s insurance coverage with the payers by reaching the administrators through calls, Interactive Voice Response (IVR), and portals. 

Updating e patient data accurately is essential. Our medical billing team gathers the patient details and gets the eligibility verification, claims details, etc. If any issues found during the eligibility verification process, the issue ought to be set out to avoid denials. Through the eligibility verification process, any miss in the patient data or the claims get updated and claims submitted error-free.

Outsourcing Makes Your Practice More Efficient

Outsourcing free up the workforce to focus on progressively productive tasks, and meanwhile improve payment and collections. The redistributed firm that you will work together with will focus on accelerating approval and co-ordinate with the insurance company concerning pending claims. Outsourcing engages you to have better control of your business. It will make your practice effective and ensure smooth working with staff and smoothed out a business process. 

About e-care India

e-care India is the top medical billing outsourcing company in India. We specialize in Insurance eligibility verification. Our company has necessary security certifications including the SSAE 18, which is an added advantage. We have a Disaster Recovery Centre to make sure that business continues even during emergency times. To know more about e-care and its services, log on to  www.ecareindia.com.

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What is Medical Billing and Coding?

Medical Billing and Coding

Medical Billing and Coding is the backbone of US Healthcare and has become the need of the hour for many physicians and hospitals. The process of Medical Billing begins right from patient registration with a Doctor’s office and continues till the servicing provider receives all due reimbursements from the insurance company which is the primary requirement for any physician and healthcare. However, their primary focus on Patient care can take their attention from prioritizing Medical Billing affecting your financial bottom line.   Additionally, the challenges and complexities involved in streamlining the medical billing process and getting them done with maximum payments for the physician mandate the role of Medical billing companies!

Continue reading “What is Medical Billing and Coding?”

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Leading And Most Common Dental Billing Errors

Dental Billing has its own challenges and any lags in Dental billing can affect the claim reimbursement. However being accurate and billing only for the exact services rendered is also primary requirement as otherwise these errors may invite unwanted legal issues to the practice, physicians, patients or all parties involved. Dental billing rules and regulations have now become more concrete and upholding high standards of integrity to avoid fraudulent billing is crucial. Listed below are few illegal or fraudulent billing errors mostly prevalent across the industry which needs to be curbed to protect the physicians and billing practices.

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Types of Process in Accounts Receivables in Medical Billing

In medical billing, accounts receivable refers to the outstanding payments owed to a healthcare provider for services rendered to patients. Managing accounts receivable is crucial for the financial health of medical practices. There are several types of accounts receivable in medical billing, each representing different stages of payment processing. Here are some common types:

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Understand Current Trends, common billing mistakes, and 6 critical things to know about Ambulatory Surgical Center Billing

Ambulatory Surgical Center Billing

Outsourcing Billing services for Ambulatory Surgical Center (ASC) simplifies the complexities and challenges involved and results in higher ROI. Offshore Outsourcing can qualify US-based Medical billing companies for greater benefits and profitability. Ambulatory Surgical Center have more specifications and specialty-based nuances in charting out the claim and processing them with the insurance payor; which makes it cumbersome and laborious to be handled In-house. Let us try to understand the complexities involved in billing for ASC to know why Outsourcing has become the latest trend in ASC specifically.

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