The healthcare system in Georgia is changing in 2025. Important updates to out-of-network referrals and prior authorizations are needed. These changes impact healthcare providers, practice managers, and billing specialists, making it essential to stay informed and compliant.
Out-of-Network Referrals: What’s Changing?
Georgia’s 2025 protocols introduce stricter guidelines for out-of-network referrals. In-network providers must now refer patients to in-network providers unless it’s an emergency. This shift aims to reduce healthcare costs and improve patient experiences.
To comply, providers must:
- Obtain written acknowledgment from patients when referring them out-of-network.
- Clearly explain the financial implications, including potential balance billing.
Prior Authorizations: Navigating New Requirements
Prior authorization requirements for out-of-network services have also tightened. Providers must secure approvals before delivering care to avoid claim denials and payment delays. Effective patient communication is key to managing expectations and minimizing financial surprises.
Documentation is Critical
Document their decision if a patient chooses an out-of-network provider after being informed of in-network options. Keep a Member Advance Notice Form on file. Be ready to give it to insurers like UnitedHealthcare if they ask. This ensures transparency and protects your practice.
Protecting Patients from Balance Billing
Georgia’s 2025 protocols aim to shield patients from surprise medical bills. In-network providers are generally not liable for balance billing related to denied benefits for non-covered services. However, always obtain written consent if patients opt for non-covered services at their own expense.
Navigating the Changes with Confidence
These updates can feel overwhelming, but you don’t have to navigate them alone. Working with a good revenue cycle management (RCM) provider is important. Claims Med is a reliable option. They can help you stay compliant and improve your revenue cycle.
Claims Med offers:
- Claims Submission and Follow-up: Ensure timely, accurate claims processing.
- Denial Management: Resolve denials and appeals efficiently.
- Payment Posting: Streamline payment tracking and reconciliation.
- AR Follow-up: Recover outstanding claims with ease.
With advanced technology and industry expertise, Claims Med helps you adapt to Georgia’s 2025 protocols while maximizing your practice’s financial health.
Take the Next Step
Don’t let regulatory changes disrupt your practice. Contact Claims Med today to learn how we can support your revenue cycle management and keep your practice thriving in 2025 and beyond.