Are Authorization Denials Costing You Thousands?
In Long-Term Care, services delivered without pre-authorization are services given away for free.
High Cost Denials
Lack of pre-authorization is one of the Top 3 reasons for claim denials, and these denials are almost 100% unrecoverable.
Administrative Effort
Providers spend an average of 30-60 minutes on the phone per authorization request.
We Get Your Care Approved—Guaranteed
LTCPro's Case Management & Authorization service acts as your expert front-line defense against authorization denials. Our team of specialists navigates the complex payer landscape for you, securing the approvals you need before care is delivered.
Navigating the complexities of healthcare authorization is essential for long-term care facilities, such as Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs). LTCPro’s specialized Authorization Services are crafted to streamline the process of obtaining necessary approvals for medical services. By minimizing administrative burdens, these services ensure that residents receive timely and appropriate care without unnecessary delays. This efficiency is crucial in maintaining high standards of care and compliance with healthcare regulations.
Timely access to medical services can significantly impact residents’ health outcomes. By efficiently managing the authorization process, LTCPro helps reduce delays in care delivery, enhance compliance with insurance requirements, and improve overall operational efficiency.
- Pre-Authorization Management: We manage the entire pre-auth process, from submitting initial requests to following up on status and securing the approval number.
- Utilization Review (UR): We handle concurrent reviews with payers to ensure continued-stay authorizations, preventing gaps in payment.
- Retro-Authorization & Appeals: If a case is missed, our team has the expertise to fight for retroactive authorizations and appeal clinical denials.
- Payer Relations: We build relationships with payer case managers, learning their specific criteria to streamline your approvals.
- Authorization Tracking: You get a clear, shared dashboard of all pending, approved, and denied authorizations.
From Referral to Reimbursed Care
Free Process Review
1 We analyze your current intake and authorization workflow to identify your biggest bottlenecks and denial hotspots.
Workflow Integration
2 We create a simple, seamless process for your admissions team to send us new patient referrals.
Proactive Management
3 Our team immediately takes over all communication with payers, securing auths and managing UR reviews.
Clear Reporting
4 We provide real-time updates on all authorization statuses, so your clinical and billing teams are always in sync.
Our Comprehensive Long Term Care RCM Services:
LTCPro offers a full suite of authorization services tailored specifically for long-term care facilities. Our services include:
- Prior Authorization Management: We handle the entire prior authorization process for various medical services and treatments, ensuring that all necessary approvals are obtained before care is delivered. This includes submitting requests to insurance providers and following up on pending authorizations.
- Insurance Verification: Our team conducts thorough verification of residents’ insurance coverage to determine eligibility for services. This step is crucial in preventing billing issues and ensuring that residents receive the care they need without unnecessary delays.
- Claims Submission and Follow-Up: LTCPro manages the submission of claims to insurance providers, ensuring that all required documentation is included. We also follow up on outstanding claims to expedite the reimbursement process, reducing the time between service delivery and payment.
- Regulatory Compliance: We ensure that all authorization activities comply with federal and state regulations, as well as industry standards. This commitment to compliance helps facilities avoid penalties and maintain operational integrity.
- Reporting and Analytics: Our services include generating detailed reports on authorization activities, including approval rates, turnaround times, and service utilization. These insights support decision-making and help facilities identify areas for improvement.
- Coordination with Healthcare Providers: We work closely with healthcare providers and specialists to facilitate the authorization process, ensuring that all necessary information is gathered and submitted in a timely manner.
- Appeals Management: In cases where authorization requests are denied, LTCPro assists facilities in navigating the appeals process. We provide support in gathering necessary documentation and submitting appeals to insurance providers.
Benefits of Partnering with LTCPro for Authorization Services
- Improved Care Access: Our efficient authorization processes ensure that residents receive timely access to necessary medical services, improving health outcomes.
- Enhanced Compliance: Our expertise in regulatory requirements helps your facility maintain compliance, reducing the risk of audits and penalties.
- Increased Operational Efficiency: Streamlined authorization processes minimize delays and administrative burdens, allowing your staff to focus on resident care.
- Better Financial Performance: By expediting claims submission and follow-up, we help improve cash flow and reduce outstanding receivables.
LTC Authorization Reports & Analytics:
- Authorization Approval Reports: Documentation of all prior authorization requests and their outcomes.
- Service Utilization Reports: Analysis of services provided to residents, helping identify trends and areas for improvement.
- Claims Status Reports: Updates on the status of submitted claims, including pending, approved, and denied claims.
- Compliance Reports: Reports ensuring adherence to regulatory requirements and industry standards.
- Appeals Management Reports: Documentation of denied authorizations and the status of appeals submitted.