Prior-Authorization Tricks and Trends

About Course
This webinar will discuss the basics of insurance coverage, eligibility, and prior authorization to assist providers in obtaining this information from insurance companies to help patients understand what their insurance will pay, and what may be their responsibility. Attendees will learn the differences between a patient’s insurance coverage, eligibility, and prior authorization and then be able to apply their knowledge in their office. Most insurance companies offer different plans that cover different services and procedures. Once an office has verified that a patient is eligible for benefits on a particular day, the coverage will determine what the insurance company will pay, and what may be the responsibility of the patient. We will also look at the ins and outs of contacting the insurance company of prior authorization and what to do in the circumstances when the procedures performed change during the surgery.
Learning Objective:
- Learn when eligibility is effective and important
- Use insurance company websites for eligibility information
- Where to go to receive the information about prior authorization
- When are retro-authorizations needed
- Reporting medical necessity on a claim
- Identify technology that may be available for efficient eligibility
- Procedures that require prior authorization
- Checklists to make sure you have the necessary information
- Meeting medical necessity based on insurance company policies
Areas Covered in the Session:
- Coverage plans and the difference between plans
- Ways to obtain eligibility and when should it be done
- Determine what services or procedures need prior authorization before they are performed
- What to do if procedures change and prior authorization is no longer correct
- Meeting medical necessity even when prior authorization has been obtained
Suggested Attendees
- Billers
- Coders
- Administrators
- Managers
- Physicians
- Claims Adjusters
- Surgery Schedulers
- Caseworkers
- Nurses
- Reimbursement Staff
About the Presenter

Course Content
You can access all the webinar materials after successful payment
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Webinar Link + Handouts PDF