Prior-Authorization Challenges and Issues for Orthopedic Procedures

What’s Covered, What’s ‘Necessary,’ and What’s Eligible for Retro-Authorizations

Prior Authorization Orthopedic Procedures – Challenges & Issues. Pre-authorizations are not optional for orthopedic procedures—they are mandatory business practice. But while common, the procedures can be complicated, oversight is high, and the bottom line is at stake. Don’t gamble with pre-authorizations—learn the facts and factors behind them.

Join senior coder Lynn Anderanin in this webinar to ready your practice to ace pre-authorizations and so you can become the office expert on the subject. Anderanin explains the difference between insurance coverage and prior authorization, the role of medical necessity, and the importance of eligibility processes before a patient is seen.

After attending the ‘Prior Authorization Orthopedic Procedures’ training, you will know how to implement an eligibility plan in your office, reduce the number of retro-authorizations, and be able to apply insurance carrier guidelines to meet medical necessity. Don’t overlook this important step—learn its details to master its processes!

Session Objectives

• How to implement an eligibility plan in your office
• How to reduce the number of retro-authorizations
• How to meet insurance carrier guidelines for medical necessity
• How to obtain the most accurate prior authorizations for maximum reimbursement

Session Highlights

• The problem of not obtaining appropriate authorization for office and surgical procedures
• Pre-authorized procedures unlikely to be performed
• What to do when the patient was not eligible for insurance coverage on the day the services were received
• What codes are authorized in arthroscopy

Who Should Attend

• Orthopedic surgeons
• Podiatrists
• Non-physician providers
• Billers and coders
• Claims reviewers and adjustors
• Reimbursement specialists
• Managers, supervisors, and administrators
• Collections staff
• Prior authorization staff
• Surgery schedulers