Obtaining prior authorization for advanced imaging procedures like MRI, CT, and PET scans is time-consuming and can delay patient care. Denials for lack of pre-authorization result in revenue loss and an increased administrative burden. We take a proactive approach by:

• Creating efficient workflows for handling prior authorization requests to speed up processing and reduce delays in patient care.
• Monitoring authorization requests and following up with payers to speed up approvals.

Radiology services are frequently denied by payers because they are not deemed “medically necessary.” Radiologists must provide sufficient evidence in their reports to demonstrate the medical necessity of advanced imaging studies, especially for specialties like Pathology, Thoracic Surgery, Gastroenterology, and Urology. Here’s how our medical billing radiology services tackle these challenges for you:

• Extensive knowledge of insurance carrier policies regarding prior authorizations
• Gather essential clinical information, including medical history, imaging indications, and diagnostic codes, to support the request
• Engage with insurance companies to clarify requirements and resolve discrepancies.
• Manage appeals for denied requests by preparing detailed appeal letters and documentation.