At 6:42 you mention a referral specialist-- and I thought, "what a dreamy world!" I'm in such a tiny clinic we wouldn't have such a thing, and I/we end up in spreadsheet hell for lack of any other way to monitor prior auths. It's a constant challenge for a small clinic, to be sure. The only thing we seem to be able to use is spreadsheets.
Spreadsheets are definitely a necessary evil sometimes. There are some EMR systems that are better with referral management than others, so I recommend exploring the capabilities of your system if not done already. If your system isn’t capable and switching to a more robust system isn’t an option, then implementing a very strict and uniform process internally is very important. Good luck!
Hi Jennifer, I’m Jeff, really appreciate your videos. I am in the process of starting my private practice as an LMHC. Do you know if prior authorizations are common in mental health services?
Hi Jeff! Thanks for watching! I’m not super familiar with behavioral health billing, but I don’t believe PA’s are common. The most likely time you’ll probably need one is if you see a patient with an HMO plan and/or you’re not participating with a patient’s HMO plan.
Great question! If you access the insurance payer portal for providers and put in the patient’s information, it should tell you if a service requires it. You can also call customer service if you provide the CPT code(s). The prescription coverage for them will speak about tiers of medications and what is required for each tear. The pharmacy would also send something back stating a prior authorization is required for a medication when they try to run it through the prescription benefits of the patient.
An Electronic Remittance Advice. It is the electronic version of an explanation of benefits (EOB) received from insurance showing how billed services were processed and the payments for each code, if any. Thank you for watching!
Starting my own business and these video are a great help. Thanks
Great to hear! Thank you for letting my me know and for watching!! Good luck on your new adventure!
Thank you
Thanks for watching!
Thank you for watching!
Nicely explained
Thank you! I appreciate the support.
At 6:42 you mention a referral specialist-- and I thought, "what a dreamy world!" I'm in such a tiny clinic we wouldn't have such a thing, and I/we end up in spreadsheet hell for lack of any other way to monitor prior auths. It's a constant challenge for a small clinic, to be sure. The only thing we seem to be able to use is spreadsheets.
Spreadsheets are definitely a necessary evil sometimes. There are some EMR systems that are better with referral management than others, so I recommend exploring the capabilities of your system if not done already. If your system isn’t capable and switching to a more robust system isn’t an option, then implementing a very strict and uniform process internally is very important. Good luck!
Hi Jennifer,
I’m Jeff, really appreciate your videos. I am in the process of starting my private practice as an LMHC. Do you know if prior authorizations are common in mental health services?
Hi Jeff! Thanks for watching! I’m not super familiar with behavioral health billing, but I don’t believe PA’s are common. The most likely time you’ll probably need one is if you see a patient with an HMO plan and/or you’re not participating with a patient’s HMO plan.
How would some one know if there insurance requires a prior authorization? Where would I check to see if P/A is need?
Great question! If you access the insurance payer portal for providers and put in the patient’s information, it should tell you if a service requires it. You can also call customer service if you provide the CPT code(s). The prescription coverage for them will speak about tiers of medications and what is required for each tear. The pharmacy would also send something back stating a prior authorization is required for a medication when they try to run it through the prescription benefits of the patient.
Hi ! What is an ERA?
An Electronic Remittance Advice. It is the electronic version of an explanation of benefits (EOB) received from insurance showing how billed services were processed and the payments for each code, if any. Thank you for watching!