Having an airtight authorization process is extremely important in ensuring reimbursement for services provided in the office. Too often an in office procedure is done with out the correct verification and the services are denied for no authorization on file. However, understanding the patients' policy is also important. One important piece of advise I give  is, if your not sure if needs an authorization, just call and ask. At times, those online verification services are too vague when it comes down to services like injections, DME, fracture care, in office procedures, etc. Call the patient's healthplan and verify this. If you are told that an authorization is NOT needed, document a reference number and name. You may need this for an appeal if services are denied when the claim is processed. Other advise I give is:

VERIFY MEDICAL NECESSITY
This is often a step missed in the decision making process of an in procedure. Now, I don't expect the physician to stop what he's doing to verify if the services are medically necessary. However, someone in the office has to take this very important step. I can not stress this one enough. I small step can save your office a lot of trouble and money.

All insurance have their own guidelines for medical necessity. Take the time to explore the websites of all insurances accepted in your practice and located the policies of your most common services. Put these together in a clear and concise spreadsheet so it can be used as a reference. Too often this is not done and a practice finds themselves with a denial and no idea why. Only to find out after the fact that the diagnosis used does not support medical necessity.

VERIFY THE DEDUCTIBLE
Many times a patient's policy will have different deductibles. Today medical policies are so complex that it is very difficult to obtain all of these deductibles at the initial verification. One verifying whethere or not an authorization is needed you should also be asking if the patient has a deductible for these types of services.

COLLECT UP FRONT
Its unfortunate, but true, if you do not collect from the patient at the time of service, it is very likely that you will have a very difficult time after the fact. Collect an approximate out of pocket for the patient. If the procedure has an allowable of $214.00, and the patient has a deductible of $125.00 remaining, collect the $125.00. It's always better to give a refund than to have to chase a patient or pay a collection agency for their service.