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Insurance Verification and Authorization within Outpatient Therapy

Healthcare organizations need to pay attention to the amount of time it takes patients to get insurance verification and authorization completed. If the process takes too long, patients will seek treatment at other facilities even if they were referred to your organization.

Insurance Verification and Authorization Benchmark

Notwithstanding patient choice, outpatient therapy providers should be able to offer an evaluation appointment within 3-4 business days of the referral. That means the insurance is verified and authorized.

Put yourself in the place of a patient or a family member who is coordinating care for a patient. After, your provider tells you that you need therapy, do you want to wait any longer than this to begin care? Probably not. It is a competitive world out there. Make sure you are meeting this benchmark.

Insurance companies want to see the evaluation and plan of care to determine the number of visits they might cover for each patient. It is also important to authorize treatments after the patient evaluation as well.

Timing is Everything

We’ve heard from our clients that they are scheduling out appointments several weeks ahead of time. We know that when this happens, the patient has two pathways.

  • Their symptoms subside to the point where they choose to not go to their therapy appointment. Their motivation to receive outpatient therapy care has decreased, but they will still need the treatment, as the problem hasn’t been fixed.
  • The patient goes to a competing organization that can schedule them in a more reasonable time frame.

Insurance verification and authorization is part of the issue but there are a number of other issues that may slow scheduling the patient in a timely manner. Capacity is a major influencer here. You should know if:

  • The scheduling system is efficient (user friendly)
  • The service is optimizing the schedule
  • The licensed therapists are leveraging the treatment services to PTAs and COTAs.
  • The service has optimized the hours of operation
  • It is time to consider hiring the next therapist(s)

Contact Blue about Outpatient Therapy Insurance Verification and Authorization

Do you know what your turnaround times are at your organization? If you were able to capture 5 to 10% of patients that seek treatment at a competitor, do you know how that would impact your bottom line?

Blue & Co., LLC,’s Outpatient Therapy Business Advisory Services provides both Assessment and Implementation Guidance to help hospitals understand their revenue and growth opportunities and facilitate changes in processes and behaviors to achieve them. These engagements are not about FTE reduction.

Contact John Britt or your local Blue & Co. advisor to learn more about Outpatient Therapy Insurance Verification and Authorization.

John Britt, Senior Manager

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