Insurance Authorizations 101

When a new patient arrives at your therapy clinic, there are several bases to cover before he or she can be treated. Along with standard intake forms and insurance verification, we recommend checking benefits and requesting an authorization. Following these best practices will protect you from the dreaded scenario in which you perform treatment and do not get paid. 

Although therapy clinic owners and admins are generally most familiar with the process of obtaining an authorization from an insurance company, it's wise for therapists to understand the process and act as another set of eyes. Let's go over the basics: 

What is an authorization? An insurance authorization is a determination by a patient's health insurance carrier that treatment is medically necessary. Since commercial insurance plans consider therapy a specialty, authorizations are required in many cases. Florida Medicaid requires authorization for all therapy disciplines. While an authorization is not a guarantee that the insurance will pay, it is much more likely that benefits will be honored when the authorization is on file.  

Why should I worry about authorizations as a therapist? You may feel that your responsibilities follow the paperwork process that your admin team normally takes care of. However, if you unknowingly treat a patient without an authorization on file, you could risk spending valuable time treating a patient and not getting paid, or experiencing a lengthy delay in payment time. In addition to the risk of lost revenue for you and your clinic owner, lack of an authorization can throw off your plan of care. Since the details in your plan of care depend upon your expectation of when a patient will meet certain goals, the amount of benefits and number of pre-approved treatments can impact whether you will be able to follow the plan. Keeping an open line of communication with your owner and admins can help you avoid any miscommunication about the type and quantity of treatment you provide your patients. 

Though you may not be responsible for requesting authorizations or attaching them to a patient's file, our expert billers at EEP advise that you check to see if there is an authorization assigned to every patient case, especially for new patients. A few moments of due diligence go a long way towards making your treatment plan and payment process as smooth as possible! 

Want to learn more about insurance authorizations? Check out how our partner EMR, TheraPlan, eases the job of a therapist by tracking authorizations for you!