Prior Authorization – Doctor's revenue services (DRS)

Priority for harmonization

Priority approval of medical services

Our preliminary approval service is approved by the insurance company for specific procedures to provide insurance coverage and reduce the risk of rejection of claims. We work with insurance companies to obtain the necessary prior approval and permission.

What is priority approval?

Priority approval is a special process of preliminary approval of medical procedures and services with insurance companies to guarantee coverage of expenses and minimize the risk of denial of payment.

Our services

Authorization is getting a medical service(s) authorized by the insurance carrier. Providers or Medical billing companies must contact insurers in advance and obtain a certification number to be reimbursed properly. These processes result in an authorization and referral number that providers/billing companies must use on claims submitted for payment.
Doctor’s Revenue Services is well aware of the Authorization and Referral process. We consider and manage it as a special project in Medical Billing Cycle because of the time and costs associated with it. Our Authorization Specialists have wide-range knowledge of functionalities and compliance with payer contractual requirements. We identify, verify eligibility, obtain insurance benefits, and ensure pre-certification, authorization, and referral requirements through all paperwork and research relevant to each case from the payers.

Preliminary approval of medical procedures

Working with insurance companies to obtain permits

Preparing documentation for approval

Controlling approval deadlines

Supporting the process of obtaining approvals

Consulting on insurance coverage

Why is this important?

How we work

Initial consultation and analysis of the situation

Preparing a package of documents for approval

Interaction with the insurance company

Obtaining preliminary approval

Control over compliance with the approval conditions

Supporting the process of obtaining medical services

What is Prior Authorization?

Prior Authorization is a process that requires healthcare practitioners to get clearance from insurance company clearance before giving certain medical treatments to patients. This process makes sure that patients get the right coverage for their treatments and that doctors and physicians get paid for their services.

Why is this important?

Avoiding financial losses when payment is denied

Saving time on receiving medical services

Protecting patients' rights

Reducing administrative burden

Guaranteed receipt of necessary medical care

When is Prior Authorization Required?

Prior authorization is typically required for medical treatments considered high-cost or high-risk. This includes treatments such as surgeries, medical procedures, and certain prescription medications. The specific medical treatments that require prior authorization may vary based on insurance company policies and regulations.

The approval process

The Importance of Prior Authorization

Another greatest contributor to lost revenue is the failure to obtain a referral or authorization before performing a procedure. The most common denial in medical billing reimbursement rates is Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Not all services and procedures require a referral or pre-authorization. However, if a referral or pre-authorization is required and is not obtained, reimbursement for the procedure is put at risk.

We Obtained prior authorizations and referrals from various payers by submitting clinical information via fax and online payer’s web portals or by speaking directly to a case management representative. We ensure end-to-end, timely, and accurate submission of prior and retro authorization and referral requests to the payers. We pledge to make everyone aware of any changes or implementations that may impact your financial growth.

Analysis of medical documentation

Assessing the need for preliminary approval

Preparing a justification for the insurance company

Submitting an application for approval

Monitoring the approval process

Obtaining a final decision

Entrust the approval of medical services to professionals – this is a guarantee of timely receipt of the necessary care!

FAQ

What is medical billing?

Medical billing is collecting and processing claims for different types of healthcare services. It involves tracking patient information such as insurance coverage, deductible amounts, and other details about a patient’s medical history to ensure that all patients receive appropriate care.
Also, a baseline of charges is established for each patient who received care to calculate the amount owed by insurance companies and third parties.
Medical billing is a crucial part of the healthcare system, as it ensures that all insurance companies and patients receive their respective share of the cost of treatment.

How do you handle HIPAA compliance?

We take HIPAA compliance very seriously and have implemented strict policies and procedures to ensure that all patient information is confidential and secure. We also regularly review and update our security measures to ensure they are up-to-date and effective.

What services do you offer as a medical billing company?

We offer various medical billing services, including billing, coding, and collections. We also offer specialized services such as Credentialing, Denial Management, Account Receivable, and Virtual Medical Scribes.

Why do I need medical billing services?

Keeping up with the constantly changing regulations and medical billing requirements can be time-consuming and overwhelming, especially for small practices. Outsourcing your billing to a professional service can save you time and money and ensure that your claims are processed accurately and efficiently.

How does medical billing outsourcing benefit my practice?

Outsourcing your medical billing to Doctor’s Revenue Services can save you time and money while ensuring that your billing and coding are accurate, up-to-date, and fully compliant with all relevant regulations and standards.

What are the qualifications of your medical billing and coding experts?

Our team is composed of highly trained and certified medical billing and coding experts with years of experience in the industry.
Also, a baseline of charges is established for each patient who received care to calculate the amount owed by insurance companies and third parties.
Medical billing is a crucial part of the healthcare system, as it ensures that all insurance companies and patients receive their respective share of the cost of treatment.

How do I get started with your medical billing services?

What sets Doctor's Revenue Services apart from other medical billing services?

We truly care about our clients and their success. We take the time to understand their needs and tailor our services accordingly. We also have a team of professionals who are passionate about what they do and are committed to providing the best possible service.

What is required for initial credentialing?

Initial credentialing typically requires a completed application, proof of education and training, and verification of licensure and insurance.

How much does credentialing cost?

The cost of credentialing can vary depending on the healthcare organization or insurance company. At Doctor’s Revenue Services, we strive to provide affordable and competitive pricing for our clients.

What are the common mistakes in medical billing and coding?

In medical billing and coding, common mistakes occur. Most of these need to be corrected: incorrect patient information, coding errors, incomplete documentation, not verifying insurance coverage, improper use of modifiers, duplicate billing, missing filing deadlines, failing to follow up on denied claims, insufficient training and education, and ignoring updates and changes.
Such mistakes might result in refused claims, delayed payouts, compliance problems, and missed revenues.

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