Learning Objectives:

• Understand the difference between insurance coverage and prior authorization
• Realize the role medical necessity plays in the authorization and reimbursement process
• Learn the importance of eligibility processes before the patient is seen
• Implement an eligibility plan in their office
• Reduce the number of retro-authorizations
• Apply insurance carrier guidelines to be able to meet medical necessities.
• Obtain the most accurate prior authorizations for maximum reimbursement

Areas Covered in the Session

• Insurance Companies websites for prior authorization
• Medicare procedures that require an authorization
• Medical necessity and where can the information be found
• Working with scenarios when what was authorized is not what was done
• Other ways to find out information about prior authorization
• Eligibility vs.  prior authorization
• The use of technology for authorization
• Medicare information related to medical necessity and how different it can be from one geographical location to another
• Denials caused by prior authorization troubles and how to appeal them

Suggested Attendees

• Billers
• Coders
• Administrators
• Managers
• Supervisors
• Physician
• Non-Physician providers
• Qualified Healthcare Professionals
• Surgery Schedulers
• Claims adjusters
• Case Managers
• Physician Assistants
• Revenue Cycle Staff
• Caseworkers
• Nurses
• Reimbursement Staff
• Practice Manager
• Insurance Claim Processors
• Reimbursement Specialist and Staff
• Non-Physician Practitioners

About the Presenter