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L.A.Burgess, LLC We help practices recover denied claims with a passion for education and commitment to our clients!

Portals Are Not Enough — Always Call🚫 Don’t trust the portal alone — it’s not built for CPT-specific accuracy.❌ Portals ...
16/08/2025

Portals Are Not Enough — Always Call

🚫 Don’t trust the portal alone — it’s not built for CPT-specific accuracy.

❌ Portals can be outdated, incomplete, or not synced with the payer’s actual authorization system.
❌ They often fail to show prior authorization requirements for specific CPT codes.

✅ Best practice: Skip the guesswork. Call the payer directly with the CPT code(s) and document their response and reference number in the chart.

🛡 One quick call can protect thousands in revenue and prevent patient frustration.



The Cost of Not Calling💸 One missed phone call = One denied claim.Example:❌Portal says MRI is covered❌No call made to co...
16/08/2025

The Cost of Not Calling

💸 One missed phone call = One denied claim.

Example:
❌Portal says MRI is covered
❌No call made to confirm CPT-specific prior auth requirement
❌Claim denied: “Authorization required”
❌$2,500 in lost revenue + upset patient

📌 Lesson: Always confirm with the payer — not just the portal — especially for high-cost services.




The Portal Problem – Availity vs. Payer⚠ Example: Availity may show a service is active… but the payer uses Carelon for ...
15/08/2025

The Portal Problem – Availity vs. Payer

⚠ Example: Availity may show a service is active… but the payer uses Carelon for imaging authorizations.

❌ The two systems don’t always sync.
❌ Coverage shown online doesn't address Prior authorization status.

💡 Best practice:

1. Call the payer to confirm CPT-specific requirements.

2. Document the reference number in the patient chart.





📞 Don’t rely on portals alone — pick up the phone.Many online verification tools don’t display CPT-specific requirements...
15/08/2025

📞 Don’t rely on portals alone — pick up the phone.

Many online verification tools don’t display CPT-specific requirements for prior authorization or coverage.

✅ By calling, you can:

Confirm if a service is covered

Check if prior authorization is needed for that exact CPT code

Ask about visit limits or special conditions

🛡 Protect your revenue — a quick call can prevent weeks of denial appeals.


Front Desk + Billing = Denial Prevention Team🏢 Front Desk: Collects accurate insurance & patient data at check-in.💼 Sche...
14/08/2025

Front Desk + Billing =
Denial Prevention Team

🏢 Front Desk: Collects accurate insurance & patient data at check-in.

💼 Scheduler or Billing: Reviews benefits, gets prior auth, flags coverage gaps.

🛡 When all work together, denials drop, revenue flows, and patients get timely care.

💡 Revenue cycle success is always a team sport.


#
FrontDeskMatters

Key Verification Questions — Ask every time you confirm benefits:1️⃣ Is the policy active for the date of service?2️⃣ Wh...
14/08/2025

Key Verification Questions

— Ask every time you confirm benefits:

1️⃣ Is the policy active for the date of service?
2️⃣ What is the copay amount?
3️⃣ Has the deductible been met?
4️⃣ Is prior authorization required for this service?

📌 Pro tip: Get the payer rep’s name and a reference number for your records.



Key Verification Questions:📝 Ask these every time you verify benefits:Is the policy active?What’s the copay?Deductible m...
13/08/2025

Key Verification Questions:

📝 Ask these every time you verify benefits:

Is the policy active?
What’s the copay?
Deductible met?
Provide frequent CPT codes to verify if prior authorization is needed, or provide surgery or imaging codes when you need to schedule an appointment.

📲 Making calls for eligibility checks = more accurate, and trackable.


📝 When verifying benefits, don’t just confirm coverage — dig deeper.Always ask the payer:✅Is prior authorization require...
13/08/2025

📝 When verifying benefits, don’t just confirm coverage — dig deeper.

Always ask the payer:

✅Is prior authorization required?
✅Is a referral needed from the P*P?
✅Are there limitations on visits or services?
✅ Record the reference number from the call or portal in the patient’s chart.

This creates a paper trail if the payer tries to deny the claim later.

⏳ A few extra minutes now can save hours of appeals work later.


12/08/2025

💥 Imagine this:
Your office schedules a $8,000 outpatient surgery. The provider performs and documents it flawlessly. The patient recovers well.

Then the insurance claim comes back: DENIED.

Reason? No prior authorization on file.

❌ The payer isn’t responsible for payment without pre-approval.
❌ The patient is upset.
❌ Contractually the patient is not responsible
❌ The practice just lost $8,000 in revenue.

🛡 Lesson: Always check if prior authorization is required before scheduling, and document the approval number in the patient’s chart.

Prevention here takes minutes.

Losing revenue takes seconds.





Top Verification Mistakes.⚠️ Top Verification Mistakes:1️⃣ Not checking secondary insurance2️⃣ Ignoring out-of-network s...
12/08/2025

Top Verification Mistakes.

⚠️ Top Verification Mistakes:

1️⃣ Not checking secondary insurance
2️⃣ Ignoring out-of-network status
3️⃣ Forgetting to confirm deductible & copay

📖 Real Example: Surgery denied for lack of authorization — $8,000 lost.

Double-check now, avoid headaches later.




📌 Always confirm if prior authorization is needed.Skipping this step is one of the fastest ways to get a denial, and tho...
11/08/2025

📌 Always confirm if prior authorization is needed.

Skipping this step is one of the fastest ways to get a denial, and those denials aren’t always fixable.

💡 Many payers require pre-approval for:
Imaging (MRI, CT scans):

Outpatient surgeries
High-cost medications

If you don’t have authorization before the service, the payer can legally refuse payment, even if the care was medically necessary.

✅ Best practice: Check your payer portal or call before scheduling the service. Document the approval number and date in the patient’s record.




Prior authorizations can cause major delays.⏳ Prior authorizations are one of the biggest reasons care gets delayed.💡 Al...
11/08/2025

Prior authorizations can cause major delays.

⏳ Prior authorizations are one of the biggest reasons care gets delayed.

💡 Always confirm before scheduling certain tests, procedures, or surgeries.

Missing an authorization isn’t just frustrating — it can cost your practice thousands.

Note: Having a prior authorization is not a guarantee of payment



Address


32806

Opening Hours

Monday 08:00 - 18:00
Tuesday 08:00 - 18:00
Wednesday 08:00 - 18:00
Thursday 08:00 - 18:00
Friday 08:00 - 18:00

Telephone

+18554875860

Website

https://stan.store/BurgessMultiservice

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