While physicians decide which treatments, procedures, diagnostics, and medications are best for their patients, it is ultimately the patient’s choice if they move forward with a mapped out care plan. Unfortunately, in many cases, patients feel that decision isn’t truly theirs due to financial status. This is especially true depending on what services will be covered by insurance (if the patient has insurance at all).
Some insurance providers require prior authorization before specific medical treatments, diagnostic tests, procedures, or medications can be administered. If a health plan requires prior authorization and the medical practice doesn’t obtain it in advance, then a claim may be rejected. Prior authorizations prevent patients from receiving surprise medical bills for services they assumed their insurance would cover.
If prior authorizations are not done correctly and the insurer declines to cover the cost, then the paying responsibility falls to the patient. According to the U.S. Census Bureau, 20% of Americans can’t afford to pay their medical bills.
When payments aren’t received, the medical practice absorbs the costs of their services. This negatively impacts the practice’s bottom line.
Practice management software makes it easier for medical practices to track prior authorizations for each patient to help ensure timely reimbursements.