According to America’s Health Insurance Plans (AHIP), prior authorizations are required to ensure the patient is receiving a safe treatment that is medically necessary and appropriate.
Health insurance companies have the unique advantage to see how a patient is utilizing their coverage and what treatments they have already received. The prior authorization process helps prevent duplicate and unnecessary tests and treatments while ensuring the patient is receiving the proper care for their condition.
Prior authorizations are necessary in healthcare but can be a burden for healthcare practices and hospitals.
Are you struggling with prior authorizations in your healthcare facility? Are denied prior authorizations impacting your ability to provide timely patient care?
You aren’t alone.
And you may be asking yourself, how do I speed up the prior authorization process? Well, we are here to bring your our tried and true best practices to ease the prior auth process.
We go into the details of all of these later in the article. Keep reading!
During our Prior Authorizations Best Practices webinar, 35% of poll respondents noted that “Delay of Care” is the #1 challenge with prior auths.
And 32% noted that “Administrative Burden” is where they struggled. This article highlights 16 tips and tricks that we use every day at Azalea Health.
These tips fall into 5 key best practice categories for managing prior authorizations in medical billing:
Familiarize yourself with payor requirements.
Every payor has different requirements. Not to mention, there are variances by type of service rendered. This makes it challenging for anyone to stay up-to-date on payor requirements.
Here are some easy tips to help you manage the nuances for each of your major payors.
Especially when it comes to common procedures in your facility, creating a list of required prior auths for each payor will streamline your process and reduce call times.
Anytime you receive a denied authorization, track the reason and the payor. Collaborating on this document with the team helps prevent making the same mistake in the future.
Doing this will help you stay informed about any regulatory and prior authorization guideline changes.
There are a lot of great resources for keeping track of industry requirements around prior authorizations. We like the American Medical Association for the most up-to-date information.
Streamline and optimize your workflow to promote efficiency!
Physicians and staff spend over 20 hours a week on prior authorizations. That’s a lot of time you could be using elsewhere. Optimize your workflows to be more efficient and help reduce delays in patient care with these tips.
Like the saying goes, “repetition is the key to learning.” Handling prior auths on a day-to-day basis will make staff more efficient and more aware of each payor’s nuances. Readily knowing these processes can speed up the time it takes to obtain a prior auth.
When the front office staff knows what procedures require prior auths in advance, they can make sure the patient gets scheduled in a timeline that corresponds with the approval.
Still using paper? Don’t worry, 49% of our poll respondents track their prior auths on paper. The best practice we recommend is to see if your EHR provides functionality to help you track the authorization process. If not, consider adopting collaborative spreadsheets to help keep everything in one place.
It is 2019 and technology isn’t going anywhere. Take advantage of the online payor portals for prior authorizations. The time it takes to initiate an authorization online is over 50% faster than by phone or fax.
Document, document, document!
Documentation is a critical part of the prior authorization process, both for keeping your work list up to date and the processing of the authorization. Here are some of our favorite tips to document the prior authorization process.
You know what payors you work with the most. Maintaining a list of quick ways to contact them will help you process prior authorizations more quickly.
One of the common causes for a denied pre auth is lack of clinical documentation. Ensure that your providers are accurately documenting on a patient, including ensuring their medications are up to date.
Keeping a record of who you spoke with, date and time, and a reference number will help if and when you need to appeal a denial.
Don’t forget to follow up!
Even though most payors send notifications that the authorization was approved, sometimes it’s not in real-time. Following up on prior authorizations in a timely manner can help alleviate some of the delays in obtaining an authorization and providing patient care.
Don’t rely on the payor to communicate approved authorizations in a timely manner. Follow up with them every 48 – 72 hours to ensure you are informed of the status.
Prioritize the authorizations to be worked by schedule date. And if you want to be even more efficient, group by payer to reduce the amount of time spent bouncing from payor to payor.
By having an estimated timeline, you can prioritize your follow ups accordingly.
Be sure to engage your patients!
Patients are becoming more engaged in their healthcare. And that means they want to know more, including some of the back office processes. When you take the time to inform your patients of the process, they are more likely to be tolerant of delays in care.
Many patients are unaware of the complexities and time it takes to obtain an authorization from the payor. Educate them on the process to help reduce the patient’s frustration towards the healthcare facility.
Keep your patients in the loop on the prior authorization process and the impacts it may have on getting their procedure scheduled. Patients are more likely to be patient if they know why they are waiting.
Prior Authorizations are hard, but these tips can make them easier.
If you would like to share any of your favorite tips and tricks, we would love to hear them! You can send them to firstname.lastname@example.org.
Get info on the latest industry news and regulations, thought-provoking webinars, events and tradeshows!