Complete Prior Authorization Services | Prior Authorization Process GuidelineMichael Smith
Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
DME Billing - http://sunknowledge.com/dme-billing-services/
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
LinkedIn - https://www.linkedin.com/company/sun-knowledge
Google plus - https://plus.google.com/+SunknowledgeInc
We act as the perfect facilitator between you & the Payer, eliminating all errors in the process of Pre-certification. Our full suite of Practice Management services includes a comprehensive and highly streamlined prior approval process that includes a) sending out the auth request, b) following up with the Payer, and c) obtaining the approval.
In addition, we also extend our support with fast and accurate patient eligibility verification and benefits verification that help prevent nasty surprises at the time of seeking reimbursement from insurance companies.
Looking for proven expertise in a dedicated niche? That's us!
As a disciplined vendor, we aim to centralize practices,
streamline them, reduce errors and improve overall efficiency.
Key Benefits
~ 70% reduction of operational cost... guaranteed!
~ Increase your current rate of successful authorizations by 1.5 – 2x
~ Full-range Prior Authorization service (Auth Request + Follow-up + Approval)
~ Prompt service with 99.9% accuracy
~ 100% HIPAA compliance
~ Highly competitive prices, with no overhead - no overtime - no hidden costs!
~ 7+ years of experience in claims adjudication for leading Payers
~ Free your in-house team for focusing on care management issues
~ Zero lockup service contracts that you can cancel anytime
WHAT WE COVER
We do prior authorization for DME (Durable Medical Equipment), CPAP Machines, Orthotics & Prosthetics, Allergy, Oncology, Physician Services, Nursing Homes, Radiology, Specialty Pharmacy, Home Healthcare, Anesthesiology, Dermatology, Imaging, Rehab, Cardiology, Physical Therapy, Sleep Medicine, Gastro Enterology, Pain Medicine, Rheumatology, Clinical Care Management, Podiatry, Neurology,
Pulmonology, Urology, General Surgery, Obstetrics & Gynecology, Ophthalmology, Orthopedics, Otolaryngology Medical Practice and more!
Certain insurance companies require prior approval to give coverage for medications. Prescribing physicians must gain approval before billing their claims to avoid denials.
All You Need To Know About Insurance Prior Authorizations In HealthcareGaryRichards30
Prior authorization is the talk of the healthcare industry since the increase in specializations in healthcare. Any healthcare process has its own pros and cons. Prior authorization is no exception to that. A Health Insurance Company must verify if the patient is eligible for an insurance for a certain drug or procedure. Before the physician prescribes it to the patient, it is a common practice to parallely check for authorization from an insurance company. Watch to know more about insurance prior authorizations!
Complete Prior Authorization Services | Prior Authorization Process GuidelineMichael Smith
Sun Knowledge – A Practice Management and Revenue Cycle Management Company.
Contact Details:
New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
DME Billing - http://sunknowledge.com/dme-billing-services/
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
LinkedIn - https://www.linkedin.com/company/sun-knowledge
Google plus - https://plus.google.com/+SunknowledgeInc
We act as the perfect facilitator between you & the Payer, eliminating all errors in the process of Pre-certification. Our full suite of Practice Management services includes a comprehensive and highly streamlined prior approval process that includes a) sending out the auth request, b) following up with the Payer, and c) obtaining the approval.
In addition, we also extend our support with fast and accurate patient eligibility verification and benefits verification that help prevent nasty surprises at the time of seeking reimbursement from insurance companies.
Looking for proven expertise in a dedicated niche? That's us!
As a disciplined vendor, we aim to centralize practices,
streamline them, reduce errors and improve overall efficiency.
Key Benefits
~ 70% reduction of operational cost... guaranteed!
~ Increase your current rate of successful authorizations by 1.5 – 2x
~ Full-range Prior Authorization service (Auth Request + Follow-up + Approval)
~ Prompt service with 99.9% accuracy
~ 100% HIPAA compliance
~ Highly competitive prices, with no overhead - no overtime - no hidden costs!
~ 7+ years of experience in claims adjudication for leading Payers
~ Free your in-house team for focusing on care management issues
~ Zero lockup service contracts that you can cancel anytime
WHAT WE COVER
We do prior authorization for DME (Durable Medical Equipment), CPAP Machines, Orthotics & Prosthetics, Allergy, Oncology, Physician Services, Nursing Homes, Radiology, Specialty Pharmacy, Home Healthcare, Anesthesiology, Dermatology, Imaging, Rehab, Cardiology, Physical Therapy, Sleep Medicine, Gastro Enterology, Pain Medicine, Rheumatology, Clinical Care Management, Podiatry, Neurology,
Pulmonology, Urology, General Surgery, Obstetrics & Gynecology, Ophthalmology, Orthopedics, Otolaryngology Medical Practice and more!
Certain insurance companies require prior approval to give coverage for medications. Prescribing physicians must gain approval before billing their claims to avoid denials.
All You Need To Know About Insurance Prior Authorizations In HealthcareGaryRichards30
Prior authorization is the talk of the healthcare industry since the increase in specializations in healthcare. Any healthcare process has its own pros and cons. Prior authorization is no exception to that. A Health Insurance Company must verify if the patient is eligible for an insurance for a certain drug or procedure. Before the physician prescribes it to the patient, it is a common practice to parallely check for authorization from an insurance company. Watch to know more about insurance prior authorizations!
E-Prescribing Controlled Substances: Opportunities and Experiences - May 2014...Forward360 LLC
Electronic prescribing of controlled substances (EPCS) is legal all but a few remaining states and represents opportunity to lessen fraud, improve care efficiency and support patient safety. Gaps in awareness and education have hindered necessary industry adoption and collaboration Knowledge of the facts, real-life experience and techniques provides a road map for adoption and success.
For more current information, check out www.getEPCS.com
The Art of Practice Management Dental Pearls - October 2016Marianne Harper
An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
E-Prescribing Controlled Substances: Opportunities and Experiences - May 2014...Forward360 LLC
Electronic prescribing of controlled substances (EPCS) is legal all but a few remaining states and represents opportunity to lessen fraud, improve care efficiency and support patient safety. Gaps in awareness and education have hindered necessary industry adoption and collaboration Knowledge of the facts, real-life experience and techniques provides a road map for adoption and success.
For more current information, check out www.getEPCS.com
The Art of Practice Management Dental Pearls - October 2016Marianne Harper
An insightful and informative newsletter from the Art of Practice Management. A dental practice management consulting company that focuses on revenue and collection systems, front desk systems and forms, dental insurance processing, medical/dental cross-coding systems and employment-law compliance.
All product and company names mentioned herein are for identification and educational purposes only and are the property of, and may be trademarks of, their respective owners.
Compliance and Legal Risks in Laborist, Surgicalist, and Hospitalist Arrangem...MD Ranger, Inc.
Have you structured your hospital-based physician contracts to address all aspects of compliance?
Hospitalist agreements involve unique compliance and financial issues, particularly when global payments and advanced practice providers are involved. Risks include indirect compensation, billing and other compliance issues. This presentation will discuss compliance risks and provide guidance on how to structure compliant contracts and business arrangements.
Artificial intelligence (AI) is everywhere, promising self-driving cars, medical breakthroughs, and new ways of working. But how do you separate hype from reality? How can your company apply AI to solve real business problems?
Here’s what AI learnings your business should keep in mind for 2017.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
Top Goals for Physicians to Implement In Their Facility.pptxalicecarlos1
Let's understand how our medical billing and coding experts help with Top Goals for Physicians to Implement In Their Facilities.
Read More: https://bit.ly/3LFPThv
I need the follwoing assignmentThe project is the creation of a w.docxnatishahaen
I need the follwoing assignment:
The project is the creation of a white paper.
Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Three, and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
†
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
†
Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
†
Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
†
Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
†
Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on
pay for performance incentives
Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals vary in size, location, and focus.
Becker’s Hospital Review
has an excellent .
Hello, I need assistance with the following I need assistance.docxisaachwrensch
Hello, I need assistance with the following:
I need assistance with the following, would you be able to assist?
The project is the creation of a white paper.
Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Three, and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
†
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
†
Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
†
Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
†
Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
†
Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on
pay for performance incentives
Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals var.
How to Improve Medical Billing Department.pdfScottFeldberg
Evaluate the existing billing processes and identify areas that can be streamlined to reduce errors and improve billing efficiency. To streamline medical billing operations, list down all billing and coding activities starting from appointment registrations up to receiving insurance/ patient payments. Medical billing activities include patient registrations, charge capture, medical coding, claim submission, claim follow-up, payment posting, denial management, patient billing and collections, accounts receivable management, and reporting. All these billing activities needs to be streamlined and documented properly for staff reference.
How to Improve Medical Billing Department.pdfScottFeldberg
Improving the medical billing department is crucial for the success of any healthcare facility. Efficient medical billing department not only ensures smooth day-to-day operations but also ensures financial sustainability in long term.
How to Improve Medical Billing Department.pptxScottFeldberg
Evaluate the existing billing processes and identify areas that can be streamlined to reduce errors and improve billing efficiency. To streamline medical billing operations, list down all billing and coding activities starting from appointment registrations up to receiving insurance/ patient payments.
How to Improve Medical Billing Department.pptxScottFeldberg
Improving the medical billing department is crucial for the success of any healthcare facility. Efficient medical billing department not only ensures smooth day-to-day operations but also ensures financial sustainability in long term.
Healthcare ReimbursementI need help on the following assignment C.docxCristieHolcomb793
Healthcare Reimbursement
I need help on the following assignment: Create a white paper. I have coompleted the first part and can provide it to you for help on the second part of the paper.
Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Three, and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
†
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
†
Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
†
Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
†
Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
†
Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on
pay for performance incentives
Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an i.
Understand Basics Of Family Practice Medical Billing.pdfRichard Smith
Family practice medical billing is an essential aspect of the healthcare industry. Accurate and timely billing ensures that healthcare providers receive payment for the services they provide to patients. This, in turn, enables healthcare providers to maintain their operations, invest in new technologies, and provide the best possible care to their patients.
Understand Basics Of Family Practice Medical Billing.pptxRichard Smith
Family practice medical billing is an essential aspect of the healthcare industry. Accurate and timely billing ensures that healthcare providers receive payment for the services they provide to patients. This, in turn, enables healthcare providers to maintain their operations, invest in new technologies, and provide the best possible care to their patients.
Understand Basics Of Family Practice Medical Billing.pptxRichard Smith
Family practice medical billing is an essential aspect of the healthcare industry. Accurate and timely billing ensures that healthcare providers receive payment for the services they provide to patients. This, in turn, enables healthcare providers to maintain their operations, invest in new technologies, and provide the best possible care to their patients.
Understand Basics Of Family Practice Medical Billing.pdfRichard Smith
Family practice medical billing is an essential aspect of the healthcare industry. Accurate and timely billing ensures that healthcare providers receive payment for the services they provide to patients. This, in turn, enables healthcare providers to maintain their operations, invest in new technologies, and provide the best possible care to their patients.
Here at Bikham we work closely with your laboratory staff to develop strategies in overcoming any kind of payor challenges, handle appeals as well as advocate on behalf of your laboratory for reimbursement. Bikham! A place with that provider-centered approach for your flourishing laboratory billing services. call us anytime.
.
Key Assignment Draft
Part 1 Tasks (Week 4 )
Training Manual
In this assignment, you will develop a training manual that will be utilized for training new employees (certified medical administrative assistants [CMAAs]) who join the clinic.
Physicians are hiring more CMAAs to help manage the increasing complexities of patient care and practice management, while also helping to implement cost-effectiveness and efficiency. The responsibilities of a CMAA can be tailored to the needs of the practice. You will manage front-office functions, manage patient flow, and handle a wide range of tasks that have been discussed in the past few weeks. As a CMAA, you may convey clinical information on behalf of the physician and follow clinical protocol when speaking with patients, but you cannot exercise independent medical judgments. You will also help to optimize patient flow, enabling the physician to see more patients with efficiency, all while following your State’s scope of practice and working under the supervision of a licensed physician.
Note:
Content from Weeks 1
–
3 IPs and DBs can be wholly or partially used as necessary to address the specific Key Assignment tasks shown below. You should take into account any instructor feedback from those IPs and DBs.
The project deliverables are as follows:
Training Manual
Title page
Course number and name
Project name
Your name
Date
The training manual should include the following topics:
An introduction to the health care system
The organization’s structure
The process of checking patients in and out
Scheduling patients
Various community and patient resources
Processes for how to interact with patients
Health insurance plans
Financial procedures related to the policies of the organization
Clean claims
Financial procedures related to the organization’s cash flow
Billing policy and procedures
Protecting patients' privacy
Accounting and bookkeeping procedures and processes
Office procedures for various forms of documentation (release of information, electronic health record)
Health Insurance Portability and Accountability Act (HIPAA) rules and regulations
HIPAA forms
Advance directives
Medical record responsibilities
Obtaining patient demographics and insurance information
Receive, triage, and route phone calls
Review records for medical necessity
Release of information guidelines
...