Managing Insurance Companies Is Now A Full Time Role

Insurance companies are getting more complex and it seems as if more claims than ever are being denied. At the practice level it’s easy to use your billing group, either on site or 3rd party, to manage the submission of claims and the modification of claims to keep your revenue cycle on track. However, the prior authorization process is becoming more common and the need for advanced levels of staff (Dr., NP, PA) to complete these calls are becoming the standard. In the past medical assistants and desk staff could manage the prior authorization process but now these conversations are becoming more clinical and it is requiring revenue generating staff to complete these calls. Without a proper staffing plan the need to have clinic staff complete peer to peer reviews and chart audits can have the following impact on the practice:

-Lower revenue due to the provider needing to be on the phone instead of seeing patients

-Poor patient care due to a provider needing to schedule around this peer to peer review call or needing to be available for an authorization once the person on the other end becomes available

-Creating staffing plans to accommodate these calls during the work day

As these calls become more common the need to potentially dedicate full time clinical staff solely for the purpose of completing clinical phone calls to justify the work of the practice may not be too far on the horizon.