At EMBER, we frequently encounter questions about our authorization services for medical practices. However, we have chosen to prioritize accuracy and efficiency in charge entry, claims submission, patient balance billing, and proactive rejection and denial management, rather than offering authorization services. In this article, we explore the reasons why certain medical billing providers might opt not to handle authorizations, shedding light on their scope of services, complexity concerns, resource limitations, and more.

Scope of Services

Some medical billing companies specialize in specific areas and may not include authorization services in their offerings. They may prefer to focus solely on billing-related tasks, leaving authorization responsibilities to other specialized companies or departments.

Complexity

Obtaining authorizations can be a complex and time-consuming process, especially when dealing with multiple insurance providers and various medical procedures. Certain billing companies might find it challenging to handle the intricacies involved in the authorization process.

Resources and Expertise

Authorizations demand specialized knowledge and dedicated staff well-versed in insurance policies, regulations, and the authorization process. Smaller or less-experienced billing companies might lack the necessary resources or expertise to efficiently manage authorizations.

Liability and Risk

Errors or delays in the authorization process can have significant financial consequences for healthcare providers. Some billing companies may choose to avoid potential liability and risk associated with authorizations to safeguard their reputation and financial stability.

Prioritization of Services

Medical billing companies often have finite resources and time. They may prioritize tasks directly impacting revenue generation, such as claims processing and denial management, over administrative-focused authorization services.

Relationships with Providers

Certain medical billing companies may have established relationships with healthcare providers who either handle their own authorization processes or work with specialized authorization firms. In such cases, the billing company might not want to interfere with these existing arrangements.

Conclusion

Healthcare providers should thoroughly discuss their needs and expectations with any potential medical billing company. If authorizations are vital for their practice, they should ensure that the billing company is equipped and willing to handle this aspect of the revenue cycle effectively. Alternatively, if the billing company does not provide authorization services, the healthcare provider may need to seek an alternative solution, such as working with a dedicated authorization service or managing the process in-house. Understanding the reasons behind a medical billing company’s decision to skip authorizations can guide providers in making informed choices to optimize their revenue cycle management.