Another greatest contributor to lost revenue is the failure to obtain a referral or authorization before performing a procedure as the most common denial in medical billing reimbursement rates as Pre-Authorization, Prior Authorization, Pre-Certification, and Notification. Not all services and procedures require a referral or pre-authorization, but if a referral or pre-authorization is required and is not obtained, reimbursement for the procedure is put at risk.
Authorization is the process of getting a medical service(s) authorized from the insurance carrier. Providers or Medical billing companies have to contact insurers in advance and obtain a certification number in order to be reimbursed properly. These processes result in an authorization and referral number and provider’s/billing companies must use on claims submitted for payment.
