Do you need prior authorization for Orthopedic visits? Answer: Yes. Orthopedic doctors must obtain prior authorization from health insurance companies for the patient before requesting diagnostic tests or performing specialist treatments.
And this prior authorization process means the practice is faced with a lot of admin work to ensure reimbursement for the services rendered.
How Is Prior Authorization Affecting Orthopedic Healthcare?
The prior authorization process necessary in the healthcare industry is time-consuming. Practice staff must provide details about patients and their symptoms, diagnosis details, and recommended medical procedures and treatment options for the insurance company to process the authorization request.
The health insurance may have queries before making a prior authorization decision, so the healthcare provider will need to spend time on the phone or writing letters of medical necessity instead of concentrating on patients. They may also need to respond to further queries, which results in waiting days or weeks before an authorization is granted.
Making changes could reduce the waiting period and give you more time to care for your patients.
The Challenges Of Prior Authorization
Prior authorization approvals from an insurance company is becoming more of a challenge for orthopedic surgeons. It is hard to know what services requires prior authorization. Here are the top three challenges orthopedic clinics encounter for prior authorizations.
1 – Increased Administrative Overhead
Obtaining prior authorization from an insurance company for medical services means that the practice will spend a lot of time on admin work. This results in increased administrative overhead.
No matter what insurance plans you’re dealing with, prior authorization for orthopedic procedures, such as treatments, imaging tests, and medications, is time-consuming. And putting in so much work can be frustrating when the treatment isn’t approved, or it takes weeks to answer additional questions.
To ensure approval, the provider must have all the necessary information, as an oversight could result in many frustrating phone calls that could lead to a peer-to-peer review.
And with the different insurance companies having different forms, systems, and information requirements, it can become a maze to try and figure out an efficient and effective way.
2 – Delays In Delivering Critical Care
Healthcare providers must provide insurance companies with information regarding dispensing specific medications, performing procedures, performing diagnostic tests, or providing physical therapy.
But a patient’s insurance coverage may not necessarily cover the cost of the treatment the orthopedic surgeon considers essential.
To ensure healthcare providers receive payment for services, health insurance companies require prior authorization for each service. The AMA states prior authorizations are responsible for patient care delays as prior authorization takes time and is distressing for patients.
A patient needing a knee replacement or spine surgery may suffer for several weeks before their insurance company eventually approves the authorization request.
Working with our professional insurance authorization, insurance eligibility verification, and service team at DataMatrix ensures this is faster and more efficient with fewer delays. We have an experienced team to contact the insurance company before the appointment to have the required authorization before the patient’s visit.
The patient can then be sure of receiving the necessary treatment without delay.
3 – Increased Demand For Pain Management
Regardless of a patient’s insurance plan, prior approval is necessary to go ahead with a desired treatment and surgery.
Insurance companies and government agencies require healthcare providers to apply for prior authorization, so they can determine whether or not surgeries are a medical necessity.
This process can be frustrating for the healthcare provider as it often delays the necessary treatment. During these delays, it’s often necessary to prescribe strong pain medication, which is not an ideal solution due to addiction risks.
By having the prior authorization request dealt with sooner, the healthcare provider will be able to reduce the amount of time a patient requires pain management. This significantly improves the patient experience by reducing the amount of time they have to deal with pain and discomfort before they can go through the right treatment or surgery.
Find Out How DataMatrix Can Speed Up Your Prior Authorization
Here at DataMatrix, our professional team offers tailored services for orthopedic clinics to deal with prior authorization for medical service requests and speed up the process significantly.
This procedure relieves orthopedic surgeons and admin staff of the demanding business of contacting insurance companies for approval with insurance verification services before providing patients with the necessary orthopedic care.
DataMatrix’s service is not an artificial intelligence (AI) system but a team of expert authorization professionals that shortens turnaround times, making it faster and easier for patients to schedule appointments.
Our professional team ensures that the correct information is entered on all forms, which maximizes your chance of getting treatment approved.