Send all the information you can to payers -- `Littlest thing’ can avoid denied claim
Sending the correct information to the insurance companies to show the medical need for services has become "quite a task" for patient access, says Aaron Robison, CHAA, a patient financial advocate at University of Utah Health Care in Salt Lake City.
Insurance companies routinely require information to be sent with authorization requests to ensure that the service is truly necessary and not just a preference of the ordering physician, Robinson explains.
Lisa Lenz, CPC, CMPE, administrator of the physician revenue cycle at Ann & Robert H Lurie Children’s Hospital of Chicago, says, "We have seen an increase in the amount of clinical information that needs to be sent in order to have a high-ticket medical imaging procedure authorized. Verifying that all of the pertinent information is sent with the authorization request is paramount to avoid any appeals process which could delay care."
Review process is hurdle
The time it takes for payers to authorize a procedure is a continual problem for patient access staff, says Robison. "Some insurance companies can take up to 15 business days to go over the request," he reports. "This can be quite frustrating."
Payers have clear indications on what they consider to be an urgent request, he adds. When providers say a service is urgent, the payer often disagrees because the patient’s condition is not life-threatening. "The best way to circumvent the long waiting times, I have found, is to know the best way to submit the authorization request, whether it be online, fax, or phone," says Robison.
When staff members submit a request with a clear timeframe listed for the procedure, Robison says insurance reviewers typically do their best to honor that tentative schedule. To speed the process, access send in all the information they possibly can for every authorization request.
"At this point in the healthcare industry, insurance companies are not leaving any stone unturned," Robison warns. "Sometimes the littlest thing can avoid a denial — anything from a lab result to a specific type of imaging.
