What Is Prior Authorization? Prior authorization, also known as ‘prior auth’ or P.A or pre-certification, is a standard management process in the healthcare industry where a healthcare provider gets approval from the patient’s insurance company before prescribing a...
Success in managing the revenue cycle depends on efficient handling of all the processes from patient enrollment and medical eligibility verification to medical coding and billing and payment...
With value-based care, patient eligibility verification and insurance authorization have become key factors to reckon with in medical practice management. In fact, ineligibility and failure to get...
Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME). DME must be used for a medical reason, long-lasting, with an expected life time of at least 3 years....
Efficient DME insurance verification and authorization is essential in healthcare settings, since these devices take care of myriad health issues or physical conditions faced by patients. As you...
The changes taking place in the health industry have also affected dental care. Dental practices need to be alert to verifying dental insurance verification, benefits and predeterminations before...
Most healthcare plans ask for pre-authorization for certain services rendered at a healthcare facility. The list of services may vary according to the plan and insurance company. The aim of the...
There are certain services that require pre-certification, pre-notification or pre-authorization from the insurance company. You need to make sure whether a particular service requires...
Pre-authorization or written approval from the insurance company is required for certain medical procedures (for example, outpatient surgery, MRI, CT or PET scans, chemotherapy or radiotherapy)...
Cardiac transplantation or heart transplantation is recommended as a treatment for people having severe heart failure and severe symptoms despite providing maximum medical therapy. Heart transplants...
The United States Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) recently...
