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Why Outsourcing your Orthopedic Surgeries Prior Authorization Process is Important for your Practice?

3/13/2023

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WHY OUTSOURCING YOUR ORTHOPEDIC SURGERIES PRIOR AUTHORIZATION PROCESS IS IMPORTANT FOR YOUR PRACTICE
​Orthopedic surgeries are some of the most complex and delicate procedures in the field of medicine. In order to ensure that these procedures are carried out safely and efficiently, orthopedic surgeons require authorization from insurance companies. This process is known as prior authorization, and it can be time-consuming and cumbersome. That's why outsourcing prior authorization is becoming increasingly popular in the field of orthopedic surgery. In this article, we will discuss the importance of outsourcing orthopedic surgery prior authorization and how it can benefit both patients and healthcare providers.

​​What is Prior Authorization?

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WHY OUTSOURCING YOUR ORTHOPEDIC SURGERIES PRIOR AUTHORIZATION PROCESS IS IMPORTANT FOR YOUR PRACTICE
​Prior authorization is a process used by insurance companies to determine whether they will cover the cost of a medical procedure or treatment. This process requires healthcare providers to submit detailed information about the procedure or treatment, including medical records, diagnosis codes, and treatment plans. Insurance companies review this information to determine whether the procedure or treatment is medically necessary and covered by the patient's insurance policy.

The Importance of Prior Authorization for Orthopedic Surgery
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WHY OUTSOURCING YOUR ORTHOPEDIC SURGERIES PRIOR AUTHORIZATION PROCESS IS IMPORTANT FOR YOUR PRACTICE
Orthopedic surgeries are among the most expensive and complex medical procedures. These surgeries require specialized equipment, highly trained surgeons, and a team of medical professionals to provide the necessary care before, during, and after the procedure. Prior authorization ensures that patients receive the appropriate care and that insurance companies cover the cost of the procedure.
​

Orthopedic surgeons must navigate a complex maze of regulations and guidelines when seeking prior authorization for their patients. Failure to comply with these guidelines can result in denied claims, delays in treatment, and increased costs for patients. By outsourcing the prior authorization process, healthcare providers can ensure that they are complying with regulations and guidelines and reduce the risk of denied claims.

Benefits of Outsourcing Orthopedic Surgery Prior Authorization
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WHY OUTSOURCING YOUR ORTHOPEDIC SURGERIES PRIOR AUTHORIZATION PROCESS IS IMPORTANT FOR YOUR PRACTICE
Outsourcing prior authorization can provide numerous benefits for healthcare providers and patients. Some of the key benefits include:
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1. Increased Efficiency:
Outsourcing prior authorization allows healthcare providers to focus on patient care, rather than administrative tasks. This can improve efficiency and reduce wait times for patients.

2. Cost Savings:
Outsourcing prior authorization can help healthcare providers reduce administrative costs associated with the process, such as staffing and training expenses.

3. Improved Accuracy:
Outsourcing prior authorization to specialized third-party companies can ensure that the process is handled by experts who are familiar with the regulations and guidelines for orthopedic surgeries. This can reduce the risk of errors and ensure that claims are approved promptly.

4. Faster Approval:
Outsourcing prior authorization can result in faster approval times for claims. This can help patients receive the necessary treatment more quickly and reduce the risk of complications.

5. Improved Patient Satisfaction:
​By reducing wait times and improving the accuracy of prior authorization, outsourcing can improve patient satisfaction and lead to better outcomes.
​Outsourcing prior authorization for orthopedic surgery can provide numerous benefits for healthcare providers and patients. By improving efficiency, reducing costs, and increasing accuracy, outsourcing can help healthcare providers provide high-quality care while ensuring that patients receive the necessary treatment in a timely and cost-effective manner. As the field of orthopedic surgery continues to evolve, outsourcing prior authorization will become an increasingly important tool for healthcare providers seeking to provide the best possible care for their patients.

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    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio, MSC, CSPPM, CRCR, CSBI, CSPR, CSAF is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

    Current HFMA Professional Expertise Credentials: 
    HFMA Certified Specialist in Physician Practice Management (CSPPM)
    HFMA Certified Specialist in Revenue Cycle Management (CRCR)
    HFMA Certified Specialist Payment & Reimbursement (CSPR)
    HFMA Certified Specialist in Business Intelligence (CSBI)

    View my Profile on Linkedin
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  • About
    • In the News
    • Privacy Policy
    • Terms of Use
  • Leadership
  • Contact Us
  • Testimonials
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • Readers Questions
  • Artificial Intelligence Division