Blog - Pier 17 Professional Medical Billing & Management

How to Establish Medical Necessity Through a Medical Record Review

Establishing medical necessity is an important aspect of healthcare, especially when it comes to insurance reimbursement. Medical necessity refers to the requirement that healthcare services provided to a patient are appropriate and necessary to diagnose or treat a medical condition. One way to establish medical necessity is through a medical record review. A medical record […]

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Top 10 Issues With Provider Credentialing

Provider Credentialing

Provider credentialing is a crucial process in healthcare that ensures the qualifications and professional background of healthcare practitioners. Despite its importance, provider credentialing can be a complex and time-consuming process. Here are the top 10 issues with provider credentialing: Overall, addressing these issues requires careful planning, adequate resources, and a commitment to ongoing quality improvement

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What is The Difference Between a Pre-Authorization and a Post-Authorization

Insurance Authorization

A pre-authorization, also known as prior authorization, precertification, or prior approval, is used by insurance carriers to determine if the services being requested by your office are medically necessary for patients. Typically, a prior authorization request is sent before a service or procedure is provided to ensure proper payment when submitting a claim. However, submitting

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What is a Prior Authorization and Why is it Important

Insurance Authorization

What is precertification, prior authorization, or pre-approval? Today, many procedures and diagnostic tests, regardless of provider specialty, require prior authorization, but what exactly is it, and why do you need it? A prior authorization request provides information to the insurance carrier, who then will provide written confirmation that the procedure or diagnostic test can be

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Verifying Medical Insurance Eligibility for Your Patients

Insurance Authorization

There are two steps to medical eligibility verification: patient eligibility verification and provider plan participation. Both verifications are necessary to ensure proper claim processing and reimbursement. The process of determining patient insurance eligibility includes verifying the patient’s insurance coverage, all covered benefits, deductible, co-insurance, and co-payment requirements. This step confirms not only what the carrier will

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Top 15 Services Requiring Prior Authorization for Cardiologists, Interventional Cardiologists, and Vascular Surgeons

Insurance Authorization

Cardiologists face some of the most stringent pre authorization requirements of all the medical specialties. From routine echocardiography to complicated surgical procedures, insurance carriers are demanding an increasing layer of oversight over patient care through the prior authorization process. As a rule of thumb, for Cardiologists, Interventional Cardiologists, and Vascular Surgeons, the following fifteen categories

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Prior Authorizations for Cardiologists: Everything You Need to Know

Insurance Authorization

Cardiology practices face some of the biggest burdens when it comes to obtaining prior authorizations for necessary diagnostics and procedures. Today, everything from Echocardiograms, Dopplers, and Ultrasounds, to procedures like Cardiac Catheterizations and Stents require prior authorization. Interventional Cardiologists face an even higher burden when it comes to precertification requirements, often requiring patients to return

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How to Receive More Approvals on Your Prior Authorization Requests

Insurance Authorization

The first step to getting your prior authorization requests approved is to submit them with all required supporting documentation. While many insurance companies are making efforts to shorten prior authorization request turnaround time, currently between 2 to 14 business days, this process is often slow and cumbersome, and incomplete applications just add to the overall delays

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How to Create a Precertification Request

Insurance Authorization

Prior authorization requirements for diagnostics and procedures are evaluated on a case-by-case basis. There are no streamlined requirements for prior authorization among the various insurance carriers, and each case must be processed individually. For carriers requiring prior authorization, it may be obtained by phone, web portal, or other submission methods depending on carrier requirements. In any of

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