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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.

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