Prior authorization is an integral part of your home healthcare billing process, especially when the claims are to be approved by a patient’s insurance company. There are specific physical therapies, medicines and durable medical equipment involved in home healthcare that require you to obtain prior authorization from a patient’s insurance company before administering them.

While it may sound simple, the process of prior authorization in a home healthcare billing process entails a lot of hassles. The process is sometimes very time-consuming and involves administrative burdens of handling endless paperwork, repeated phone calls and mounting claim piles that can disrupt or delay patient care. A frequent problem faced by home healthcare facilities is the long waiting time for prior authorization approvals. According to a recent report by the American Medical Association, 64% of providers reported waiting at least three business days, and 30% reported waiting at least five business days. Additionally, the report revealed that 84% of providers experience high or extremely high administrative burdens due to prior authorizations, and 85% noted that issues with prior authorizations have increased over the past five years.

However, by following some PA practices in home healthcare billing, you can ensure speedy approvals and payments on time.

Perfect PA practices in home healthcare billing:

1) Keep necessary information ready:

It is important to have detailed information about the procedures that providers routinely perform. At the same time, you need to provide adequate documentation to justify the medical necessity of any therapy, medication, or procedure.

2) Follow recommended treatment guidelines:

Each expensive procedure has its treatment guidelines, which vary by payer. You must know and follow these guidelines before performing a high-cost therapy or procedure.

3) Meet payer criteria:

Criteria vary significantly between federal and private payers. It is crucial to have sound knowledge of these criteria. Understanding the entire spectrum of payer criteria ensures that you perfectly meet all requirements before submitting a prior authorization to a payer.

4) Perform Regular Audits:

Just like other important home healthcare billing steps, the prior authorization process needs regular audits. These audits help find problems and understand why prior authorizations are denied. This allows you to fix small issues early and manage the process better. Audits should also check how well diagnosis codes are recorded for accuracy.

5) Regularly Monitor Insurance Carrier Websites:

Insurance carriers frequently update their requirements. While they inform providers of rule changes, it is beneficial to regularly check their websites proactively. This routine practice helps identify issues early.

6) Have a streamlined PA process:

It is important to streamline their prior authorization process in home healthcare billing for maximum efficiency. To streamline this process effectively, it is crucial to create concise summaries for each payer. These summaries should include preferred contact methods, specific requirements, and other vital details, ensuring easy access for staff.

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To manage home healthcare billing and the complex prior authorization (PA) process effectively, many home healthcare providers choose to outsource these tasks to professional billing companies. Outsourcing allows home healthcare professionals to focus on patient care while their outsourced billing partner handles PA and other billing aspects.

If you are looking for a reliable company to manage your PA process, consider Sunknowledge. Their professionals handle the entire authorization process for home healthcare, including prompt submission of PA requests to follow-ups, thus enabling home healthcare providers to experience speedy PA approvals and prompt payment for rendered services. For more information about their comprehensive home healthcare billing and PA services, schedule a no-obligation call with one of their experts today.


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