Enhance Your Prior Authorization Approach: Better Your Practice Management Experience

It is true that a major chunk of prior authorization nightmare center on the patients not being able to receive the needed medication. Whether it is for the new prescriptions or the changes in the insurer rules, it is the patient that bears the brunt of the delays due to cancellation of procedure, prescriptions etc. However, medication may not be the only thing that physicians must submit prior authorization/ approvals for.

Let us tell you a story of a patient who was trying to replace his CPAP machine as it was falling apart. The insurance company wanted him to undergo a sleep study as it has been several years; he participated in one of them. The situation worsened rapidly from here with the insurer approving a home sleep study and the patient doing the study with the CPAP on, the study went back to normal and the insurance didn’t cover the new supplies as he did not have sleep apnea!

Only after weeks of phone calls, the insurer did pay for a new sleep study to prove the diagnosis and the new equipment finally got approved! We are likely to hear more stories like this, as the CMS has already added to its list of durable medical equipment items and the payers following suit. The entire process appears to be cumbersome with an initial prior authorization determination being made by the CMS or the contractors within 10 business days and resubmitted request being processed within 20 days.

Sunknowledge Services Inc: A complete prior authorization destination

As a complete healthcare revenue cycle management company, Sunknowledge Services Inc extends superior support in practice management. Presently, almost 50% of our business revolves around DME billing/ practice management. Our team of DME coders, prior authorization experts lay down the right checks and balances that help you in reducing risks with your reimbursements.
We offer the needed flexibility and perform task specific jobs in eligibility verification, authorization, denial management and accounts receivable collections. As a reliable extension of your existing operations, we will eliminate proven pain points in your prior authorization for DME services. The best part, we offer all our services on a standalone basis covering

• Order Entry
• Eligibility Verification & authorization
• Doctor’s office follow up
• Order Confirmation
• Scheduling of delivery

Our Billing & collections services for DME extends to

• Creation of Claims
• Claims Submission & Rejections
• Cash Posting
• A/R Follow-up
• Rejection & Denial Management

Looking for more information on our prior authorization service? Need to know how we transform your billing? We are just a call away from you! Let our team share with you, how we plan to work as your practice management/ revenue cycle management partner! Leverage the Sunknowledge advantage for your improved cash flow right now!