The Hidden Costs of Prior Authorization in Cardiology: A Billing Perspective
Almost 1 in 8 prior-authorization requests in cardiology billing get denied, which not only hinders practitioners’ revenue cycle management but also patient care. Thus, practitioners need expert help to navigate through such complexities. Cardiology care often occurs in high-acuity healthcare environments, involving various high cost and high-risk procedures. As a result of this, pre-authorizations for procedures also rise in cardiology billing. Prior authorization (PA) in medical billing is an essential step whereby practitioners acquire advance approval from insurance companies before performing specific procedures, or prescribing medications to confirm medical necessity. As per industry experts, 48% of total cardiology service procedures are subjected to prior authorization (PA) by Medicare Advantage plans. This can lead to administrative overload for practitioners, as any minor mistakes in obtaining such approvals can hinder their revenue cycle management. Thus, hiring a team ...