Should You Outsource Your Eligibility And Authorization Process?

In small to mid sized clinics, front end eligibility verification and authorization processes are usually performed by the front desk staff. Great front desk staff are hard for the average PT clinic to come by. The really good ones are even harder to keep.

The duties of PT clinic front desk staff have become increasingly complex over the last few years. A lot of this has been caused by burdensome insurer requirements along with the fact that the platforms we have to use are continuously becoming more sophisticated.

In addition there has been upward pressure on wages along with downward pressure on PT reimbursement. As clinic profits are being squeezed, it is difficult to afford what it costs to keep top notch administrative staff.

Unfortunately, if you don’t keep high-performing staff, you tend to end up with costly errors. The type of front desk errors that are easiest to place dollar amounts on are those related to errors in eligibility verification and authorization.

We have many clients that perform their own verification and authorizations. Some do it well and rarely have errors. Others make multiple errors each month.

Some of these errors may be simply entering a wrong subscriber ID number in their EMR. If the patient has active insurance, the error may just cause a slight delay in payment after the error is fixed. However, many errors occur when checking eligibility or not obtaining correct authorization. These errors are usually very costly.

It is not uncommon for small, less organized clinics to make a couple of these errors each month.

Given that this can be a significant issue, how do you know when is it time to outsource the eligibility and authorization process?

One thing to consider is that when these tasks are outsourced, the qualities that you require in your front desk become easier to find. At that point you still need someone who is organized, but most importantly cheerful and helpful. That front desk person is a lot easier to find (and pay) than someone who has to be well versed in insurance protocols and is able to make sure all your patients’ visits are covered and will be paid for.

Now let’s answer this question mathematically. Wages shown in these examples are just rough estimates. These amounts may not reflect your actual costs.

Scenario 1: In-house verification and authorization done well

Hourly rate: $15

Benefits: (approximately 10%): $1.50 per hour

Cost from errors: $0

Monthly cost: $2904

Scenario 2: In-house verification with sub par Front Desk

 Hourly rate: $12

Benefits: (approximately 10%): $1.20 per hour

Cost from errors: eg 1 patient without authorization: $1500

Monthly cost: $3823.20

Scenario 3: Outsourced verification with cheerful front desk

Cost for outsourced verification and authorization service: $250 / month

Hourly rate (front desk without the required skill of authorizations): $12

 Benefits: (approximately 10%): $1.20 per hour

 Cost from errors: zero

 Monthly cost: $2573.20

 As you can see, of these three options, the most inexpensive is to outsource your Verification and Authorization services.

 Now, your front desk pay rate and error rates are probably different to this. So do the math for yourself to see what makes sense.

 Your billing company should be providing you with data each month on front desk errors so you can see the cost of those in your clinic.

If you are still not sure if you should outsource these services, reach out to us. We’d be happy to help you understand your numbers so that you can make the best decision for your clinic.

 Matt can be reached at