Prior authorizations, sometimes also called precertification or prior approval, is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
Prior authorizations are a problem. The concept is designed to save money, reduce unnecessary or duplicate procedures and testing from occurring. The jury is out as to the effectiveness of the process. It is expensive for both the payer and the provider and solutions need to be worked out. We will address the why and how but bring it to the level of the practice as to what is currently happening and what can be done to improve and “guarantee” payments for procedures and tests done that have been authorized. There are options for the future which will be addressed and need to be considered by the individual practice.
Our expert Owen will also teach you how to work through your pre-authorization requests and improve your chances of success. You will learn how to work with payers across different avenues, discover the pros and cons of each form of contact, and understand how to organize your information systematically.
- To review and recommend revisions in YOUR process of authorizations
- To identify how to handle denials and appeals
- To set up internal audit processes to review and revise authorization processes
- To consider what the future holds
Areas Covered in the Session:
- Why authorizations from a PAYER perspective
- Why authorizations from a PROVIDER perspective
- General and basic procedures related to authorizations
- Reviewing criteria from payers related to their requirements for authorizations
- Management of denials
- Management of the appeal process
- Pre-determination vs. authorization – what are the issues and how to address
- Communicating to the providers on the need for and which procedures require authorizations, support systems in the practice to keep patient flow and care processes in place
- Documentation requirements and how to ensure communication with payer about the need and outcome of procedures performed
- Outsourcing is an option, is it worth it?
- Internal strategies to address payer requirements both current and how to reduce impact, even remove the requirement for authorizations
- Internal metrics on what, how successful and what can be done to improve or reduce issues related to lack of payment for authorizations (or not having authorizations)
- Care plan development and the application to the authorization process
- Future of authorization management – legislative, electronic (AI)
- Development of a game plan for the practice to improve management of the authorization process
Who Should Attend:
- Office Managers
- Practice Manager
- Finance Manager
- Billing Manager and Staff
- Healthcare Staff
- Revenue cycle team
- Practice leadership
- Front desk staff
About the Presenter:
Owen J. Dahl, MBA, LFACHE, CHBC, LSSMBB, is a principal of Owen Dahl Consulting, in The Woodlands, Texas. He has 53 years of experience in consulting, running a medical billing service and managing medical practices. He was also a hospital administrator. Owen speaks across the country on medical practice issues related to strategic planning, Lean and Six Sigma, culture, human resource management and the revenue cycle.
He is an adjunct professor at the University of New Orleans, the author of Think Business – Medical practice quality, efficiency and profit, contributing author of the popular book Lean Six Sigma for the Medical Practice and recently published Integration of Behavioral Health Into Medical Homes: A Rapid Implementation Guide. Owen received his Bachelor’s degree in Hospital Administration at Concordia College, Moorhead, MN and his Master’s from the University of Northern Colorado. He recently achieved his Lean Six Sigma Master Black Belt through Villanova University. He served in the USAF.
You will receive an email with login information and handouts (presentation slides) that you can print and share to all participants at your location.
Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly
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For more information you can reach out to below contact:
Toll-Free No: 1-302-444-0162