LISA FISCHER -HERDT
PRE-AUTH’S; TIME IS TICKING!
T quickly
he end of the year is
approaching. If you
are anything like me you are
probably wondering where
the year has gone. Time flies
when you’re having fun,
right? Kids back to school,
summer vacations, 2019
budgeting, the upcoming
holidays…..
approval timeframe by
two weeks
• 90% of medical plans are
calendar year policies.
Deductibles reset
January 1
• Prior Authorization date
ranges are approved for
90 days
To boost production, target
commercial insurance
patients in September
and October. DS3 can help
you identify patients that
delayed treatment via
the Tracker information
displayed on Manage
Patients feature on your
dashboard.
• Medical insurance open
enrollment is typically
January 1, which means
the patient could
potentially change plans.
What does all of this mean
for you?
Sorry, but I have one more
crucial item to add to your
list. Prior Authorizations
(PA)! Patients will seek
treatment for medical
services as their deductibles
decrease.
This occurs in the latter
portion of the year. There
should be an uptick in
patient flow over the next
few months. You will need
to keep the following in
mind as the end of the year
draws closer:
• Prior Authorizations
average four weeks to
approval
• GAP request could
potentially increase the
Timing of your PA request
is key. It is best if you have
all of your commercial
insurance patients’ PA’s
requested NO later than the
2nd week of November. This
will allow the 4-6 weeks
average processing to be
completed prior to the end
of the calendar year.
Then, in November and
December, I recommend
focusing on Medicare
patients as a PA is not
required.
As always, if you have
any questions please feel
free to contact me at
[email protected].
Additionally, you NEED to
deliver the device prior
to December 31. This is
vitally important!
I would encourage you to
speak with your third party
billing company to seek
their advice and timing of
the PA requests.
LISA FISCHER-HERDT
Director of Billing
Services, 4 Pillar Billing