Find Missing and Expired Authorizations

Today’s BIG Idea is from a practice in the Midwest who had a payer deny a claim because the pre-authorization was for one day and the day of the procedure moved.  Are pre-authorizations giving your practice headaches, too?  Listen for ideas from both AthenaPractice and AthenaOne on how to build an exception report to track appointments that may be a problem.  The first step is to reliably filter those appointments to only find appointments that need pre-authorization.  That may take standardization and consistency from your scheduling team.  The second step is to data mine to find appointments without authorization.  Some pre-authorizations are based on dates and other authorizations are based on procedure count.  Some patients have more than one appointment/procedure that needs authorization.  Matching the right authorization to the right procedure takes work.  Standardization really helps.  The process is not easy, but catching even one procedure that is has a missing or an expired authorization is well worth your time.