Authorization & Referral Management

Failure to get a referral or authorization before conducting any operation is one of the most common reasons for revenue loss. According to medical billing reimbursement rates, the most common refusal is not getting a reference or clearance prior to executing the service. Although referral and authorization management are not necessary for all treatments or procedures, if they are required and not obtained, reimbursement may be jeopardized.

When reimbursement is necessary, medical practitioners and billing businesses must get certification numbers. The procedure through which an insurance company authorizes a medical service is known as authorization. These numbers must be used on claims filed for payment by providers/billing businesses, resulting in authorization and referral numbers. One of the most significant causes of lost income when auditing a healthcare company is the failure to get a referral or authorization before executing a service.

Not all treatments and procedures require a referral or pre-authorization, but if one is necessary and not acquired, reimbursement for the operation is jeopardized. While some insurance companies will grant a retro authorization or referral, the majority will not. As everyday activities pile up, this component of the revenue cycle process is frequently overlooked and is the most costly. Using our referral and pre-authorization services ensures that the patient has been approved for the scheduled therapy or operation before arrival, ensuring that the first stage of the revenue cycle is done correctly. This ensures that the rest of the claims procedure goes smoothly.