Not performing effective pre-authorization is associated with which outcome?

Not performing effective pre-authorization is associated with which outcome?

• A. Enhanced billing accuracy
• B. Claims denials
• C. Shorter wait times
• D. Higher satisfaction

Answer: (B)

Not performing effective pre-authorization increases the risk that a payer will deny payment because the service wasn’t approved as required. When pre-authorization isn’t obtained or isn’t handled correctly, claims are more likely to be rejected, delaying or preventing reimbursement and creating extra administrative work for resubmission or appeals. This disruption in the revenue cycle can also lead to patient billing surprises and longer overall timelines, which tends to reduce satisfaction. While good pre-authorization practices can improve likelihood of payment and smooth billing, skipped or ineffective pre-authorization is most directly linked to denials.

Not performing effective pre-authorization increases the risk that a payer will deny payment because the service wasn’t approved as required. When pre-authorization isn’t obtained or isn’t handled correctly, claims are more likely to be rejected, delaying or preventing reimbursement and creating extra administrative work for resubmission or appeals. This disruption in the revenue cycle can also lead to patient billing surprises and longer overall timelines, which tends to reduce satisfaction. While good pre-authorization practices can improve likelihood of payment and smooth billing, skipped or ineffective pre-authorization is most directly linked to denials.