GeBBS Healthcare Blog

In medical billing terminology, eligibility verification, pre-authorization, prior authorization and pre-certification are terms that may be used interchangeably to mean that for certain situations and procedures, providers have to contact insurers in advance and obtain a certification number in order to be reimbursed properly (or at all) for services. Insurance verification and insurance authorization services play a vital role in revenue cycle management. In fact, most claim denials happen when a patient is ineligible for services billed by the provider.

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Healthcare IT News reported recently that nearly three-quarters (73 percent) of health systems with more than 300 beds -- and 81 percent of providers with fewer than 300 beds -- are shifting their focus to IT outsourcing for development and complex infrastructure services. Their data was based on Black Book Research that surveyed 1,030 hospital CIOs and IT leaders and 243 CFOs and financial executives from 266 hospitals and the business managers from 1,400 outpatient, alternative care and physician practices for their insights on technology and outsourcing services options.

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With patient volumes on the rise, these increased number of transactions, in the face of limited resources, mean backlogs, data entry errors, and increased days in A/R. Now is the time to get expert help for your overworked staff.

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