How to Deal With Prior Authorization in Medical Billing

The trick to a successful pre-authorization is to have the correct CPT code. The obstacle is that you must determine the appropriate procedural code before the service has been rendered (and documented)—an sometimes challenging job.

To decide the correct code, check with your doctor to find out what she anticipates doing. Ensure you get all possible scenarios; otherwise, you face the risk that the procedure that has been performed will not be covered.

Whereas the coder is responsible for assigning the correct codes, the responsibility of receiving the required authorizations is mostly on the provider because it is the provider that would be denied the payment as expected. Getting pre-authorized can save endless hours on the back, trying to chase claims payments. Pre-authorization often helps in quicker processing of claims and timely payments.