20 Mar Why will using nurses with clinical expertise for required insurance authorizations save you money?
Seeking approval from insurance companies or other payers before providing patients with certain medical services or procedures is crucial in revenue cycle management.
We see many healthcare organizations trying to save money by not using nurses to obtain the authorization, which in fact, ends up costing them more money in terms of an increasing number of denials. Plus, the nurses will also promote the quality and cost-effectiveness of patient care using their clinical insight.
Nurses can play an essential role in this process for a variety of reasons:
1. Clinical expertise:
Nurses have a deep understanding of medical conditions, treatments, and medications. This makes them well-equipped to review the medical necessity of a proposed or completed treatment and assess how it meets the criteria for prior/retro authorization.
2. Communication skills:
Nurses are skilled communicators who can effectively advocate for patients and explain the medical rationale for a particular treatment to insurance companies or other payers. They can also communicate with healthcare providers to ensure that all necessary information is provided for the prior/retro authorization process.
3. Time management:
Obtaining the authorization can be a time-consuming process, and nurses are often responsible for managing the paperwork and follow-up required to obtain approval. They can help ensure that the process is completed efficiently and without unnecessary delays. Additionally, using nurses in the authorization process can help streamline the process and reduce delays in getting patients the care they need and ensuring the claim is reimbursed by the payer.
4. Patient care:
Nurses can help ensure that patients receive the medical care they need in a timely and efficient manner, while also advocating for their best interests.
In conclusion, using nurses in the authorization process can help ensure that patients receive the appropriate care in a timely manner, while also helping to control healthcare costs by ensuring that necessary treatments and procedures are reimbursed by the patient’s health insurance.
The best part? Our utilization nurses are ready to hit the ground running and we work on a flat fee basis that will allow your budget not to fluctuate. Contact us or give us a call at (727) 278-3009 to get started.
Sunlit Cove Healthcare Consultants provide utilization nurses who have extensive knowledge and experience:
- Obtaining Medical Necessity Authorizations for payment approval
- Responding and adapting to changing market forces and regulations
- Ensuring continuity of care and accurate payment for that care
Start today and schedule your free process review!
Sunlit Cove Healthcare Consultants
We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.
Revenue Cycle Utilization Management:
At most healthcare organizations, the significant revenue cycle expenses are the ones related to human capital. Reducing costs linked with a full-time equivalent (FTE) is a primary...
Imagine if your healthcare organization could completely prevent denials from occurring. In theory, it should be an easy path to follow; utilizing basic analytics should allow your...
Implementing effective claims denial management can lower your denial rate and improve your healthcare organization’s revenue. Denial prevention is the key to improving your ...
More and more providers are generally tired of the unknowns of the claim denials. Implementing effective claims denial management will help lower the burn on your healthcare organi...
Just when you thought your utilization management staff had enough to deal with, Center for Medicare & Medicaid Services (CMS) is adding more to your back-office workload. Star...