How to Better Manage Your Prior Authorization Process

As a healthcare provider, your top priority is helping your patients improve their health and wellness. Though prior authorization process was introduced with the purpose of controlling healthcare expenditures and ensuring accurate care for the patients; with increasing complexities the process has become one of the biggest nightmares for the providers like you.

When the preauthorization requirements prevent you from providing the right level of care, it goes against everything you’ve worked for.

If the requests get denied, it’s just putting you back to square one disrupting your overall care process and revenue cycle management.

Insurers deny your prior authorization applications at an alarming rate, and that means your patients are not receiving the care and your facility is not earning accurate reimbursements.

Why Prior Authorization is Hard to Manage?

Prior authorizations are costly for healthcare practice, time-consuming for providers and potentially detrimental to the patient. The process has become a “necessary evil” in care and practice management process.

In fact, a basic Prior authorization request takes at least 30 to 45 minutes to complete. On the other hand, due to the complexities in the requirements, the process is prone to errors leading to PA denials. As a result, providers like you spend 15 hours on average to resolve an authorization denial. It is evident that it will take your valuable time away from patient care.

Recent studies have identified that, due to the complexities within the requirements, the inpatient Prior authorization denial rates have increased by 26% and for outpatients it has risen to 16%.

It has been identified by the experts that when it comes to specialty services like gastroenterology or cardiology, the prior authorization burden is even higher considering intricate procedures in treatment plan.

To treat a patient with hypertension, you may need to compile all the previous medications used by the patient, make multiple communication and have to wait for hours.

All the while your patient goes without any medication needed and their health deteriorates eventually. Not only the medications but also tests, diagnosis, surgical procedures in specialty services require timely prior authorization. This makes the process complex yet indispensable.

Preventing Prior Authorization Refusal

Approximately 13% of Medicare Advantage plan subscribers reported receiving a pre-authorization denial for a service that should have been accepted in a recent poll. It’s possible that procedural flaws, insufficient patient data, and other process issues led to these incorrect denials.

The following are some strategies to prevent incorrect prior permission denials:

• Verify the billing codes one more time.
• Make sure all names are spelled correctly.
• Give a thorough explanation of your recommendation for the treatment.
• List any therapies the patient has tried and found to be ineffective.
• Use evidence-based clinical guidelines to support your assertions.
• Overcoming the difficulties in denial management can also be facilitated by implementing appropriate revenue-cycle procedures and tools.

Furthermore, do not proceed with the procedure in issue until the previous authorization approval has been received. If not, the insurance company will refuse coverage and leave you responsible for the cost.

Wrapping Up

Pre-authorization concerns should generally be anticipated over the course of therapy. Insurance companies frequently reject requests despite your best efforts in the hopes that you’ll locate a more affordable option. You can proceed through the processes to provide your patients with the treatment they require if you appropriately budget for the additional time.

Remember that the preauthorization procedure can be streamlined with the aid of a medical billing service. The revenue-management software efficiently arranges all of your data and enhances your procedures, preventing denied claims and other problems. This will guarantee that patients receive excellent care while also you can enhance workflows.