The medical field is investing vast amounts of time and money in streamlining prior authorization. Each request requires paperwork, phone calls, and waiting for payor approval. These delays irritate both providers and patients. To alleviate this burden, some insurers and states have established a concept known as gold carding.
Gold carding provides relief by diminishing or eliminating the requirement for prior authorization for providers that constantly make correct, compliant requests. Simply put, it’s a reward scheme for good providers that can yield time savings and enhance revenue streams.
Understanding the Concept of Gold Carding
Gold carding is an initiative in which payors exclude some providers from pre-authorization for certain services. Exemption depends on the provider’s established track record of accuracy, compliance, and medical necessity. You could think of it as being a “trusted status”. If a provider demonstrates that most of their prior authorization requests get approved, the payor will issue a gold card to them.
The gold card provides the cue that they don’t have to do the standard prior authorization process for some or all of the services. This system is intended to alleviate administrative burdens while still exercising control over clinical appropriateness. To payors, it eliminates redundant work. To providers, it eliminates one of the greatest barriers to rendering timely patient care and being reimbursed.
How Gold Carding Helps Medical Practices
- Reduced Administrative Responsibilities
Gold carding greatly diminishes the amount of paperwork and manual follow-up. Staff do not spend hours maintaining authorizations, verifying approvals, or resubmitting denied claims. This saves time and saves on administrative costs.
- Speedier Patient Care
When prior approval is taken out of the way for routine procedures, patients are treated sooner. There is no delay for payor feedback, providing treatment, and receiving reimbursement because no prior approvals are outstanding. Patient satisfaction and outcomes improve.
- Increased Cash Flow
Fewer approvals mean faster billing and quicker payment. Practices spend less time stuck in the approval cycle and more time paying claims. A less cumbersome workflow means better cash flow and fewer denials.
- Increased Staff Productivity
Less stress from daily handling of prior authorization services can directly benefit the billing and front-office teams. It will free up their time for more critical activities like claim posting, payment posting, and handling denials. This can speed up and improve your revenue cycle.
- Improved Relationship Between Payor and Provider
Gold Carding promotes a sense of trust between payor and provider. When a payor realizes a provider has accuracy on a consistent basis, it generates better collaboration and fewer disputes around claim approval.
The Role of Prior Authorization Services
Outsourcing has particular benefits for practices seeking to achieve gold card qualification. Contracting with an experienced team such as RCM Workshop to outsource prior authorizations brings consistency, accuracy, and cash flow balance to your organization. It also reduces administrative mistakes that may cause delays in approval or possibly a denial.
By leveraging experienced outsourcing partners, your practice can position itself for the achievement of gold card status. Once your practice reinforces best practices for prior authorization, you can eliminate friction, lower costs, and enhance your patient experience.
