Dealing with Prior Authorization: What You Need to Know and Do

You know that most insurance companies have different rules and policies for getting prior authorization, which can make it really hard for you to handle it for medical services. Plus, insurance companies often add new services to their prior authorization list. If you get help from a professional prior authorization company, it can reduce your stress and save you a lot of time and effort.

You know managing prior authorization isn’t easy, especially if your team doesn’t have enough experience with it. For example, an AMA survey recently pointed out some big challenges that administrative staff face when dealing with prior authorization. Things like handling too many requests or keeping up with all the rules can make it super stressful and confusing.

Key challenges in prior authorization services:

Insurance companies use something called prior authorization (PA) to decide if your patient really needs a service before you can get it. But here’s the thing— a 2022 survey found that a lot of doctors think these rules can waste time and even hurt patients! Can you believe that 88% of doctors said dealing with prior authorizations is a huge hassle? To make things easier, 35% of them had to get extra help just to manage all those PA tasks! More than 80% of doctors said that prior authorization makes you wait longer to get the care you need. This can mess with how you feel and even make some people stop their treatment. That’s not good at all!

The good thing is that you still can manage your pre authorization solutions by following the strategies mentioned below-

Tips to handle your pre authorization services:

1) Understand PA properly:

Always remember that each insurance company has its own form you need to fill out when you want to prescribe a special medicine or treatment that’s not covered by their plan. You might come across a lot of different forms, and some can be really long and tricky. So, make sure you take your time to read them carefully and fill them out right, so you don’t run into any problems later!

2) Ensure accurate coding:

Make sure you write down the right diagnosis codes to show why the procedure is really needed. This helps explain to the insurance company why the service is important and makes it easier when you’re talking about getting paid back. You should also add the right CPT codes for all the treatments you are giving.

3) Make your documentation process appropriate:

Always remember that giving wrong or not enough info is a big reason why prior authorization takes so long. You can avoid this by checking if the patient needs prior auth when you’re scheduling their appointment. You’ll need details like the patient’s insurance ID, name, date of birth, what kind of procedure they need, and some IDs for the facility and the doctor. Even little mistakes, like wrong numbers or missing addresses, can cause problems and make more work for your team. Using professional insurance verification services can help you make sure everything is checked correctly for all your patients!

The service, procedure, or medicine you use has to be safe and really help your patients. It can’t be something new or experimental. To get prior authorization approved, it has to follow the accepted medical standards, be done in the right place, by qualified people, and meet what the patient really needs!

When you send in a pre-auth service request, make sure to include not just the diagnosis and procedure, but also how serious the diagnosis is, the risks of not doing the procedure, and any past treatments or tests. You want to cover everything so there aren’t any gaps that could make them ask for more reviews, deny it, or ask for extra payments! A prior authorization company can help you make sure you have all the right information and avoid problems!