Prior authorization - Practical Tips to Speed up the Process

Prior authorization is one of the indispensable tools that help patients receive safe, efficient and the right care. But, do doctors and patients like this prior authorization process? Even though prior authorization provides undeniable benefits, it’s no secret that both doctors and patients dislike it because it causes delays and hurts patient care. According to a 2021 AMA prior authorization physician survey 93% reported delays in access to necessary care due to the prior authorization process and 82% reported that it caused patients to abandon the recommended treatment entirely. In addition, physicians also felt that paperwork involved in prior authorization had gotten out of hands so much so that they were not able to focus on patient care.

According to the Medical Economics 2018 Payer Scorecard survey three out of four physicians were of the opinion that the administrative burden created by the prior authorization process was challenging. Well, let’s us in this blog discuss some of the practical tips to make the prior authorization process more efficient, while also improving patient care and outcomes.

1. Accurate and complete documentation

Prior authorization requires that you submit accurate and thorough documents so that there is adequate evidence to prove the medical necessity of a particular procedure or treatment. Hence, it is important to have all required information handy to speed up the process of prior authorizations. It also allows the practice staff to retrieve and submit information to the insurance provider, on behalf of the physician. Most importantly, accurate documentation prevents denials and the need for any follow-ups to procure additional information needed to complete the prior authorization process.

2. Take advantage of technology

With so much technological advancement in the healthcare industry many prior authorizations are still done through telephone and fax machines. Instead, make use of the electronic prior authorization solutions that easily integrate with your electronic health records, allowing physicians to get real-time updates on the status of the requests. This option not only makes submitting prior authorizations more efficient and quick than ever but also cuts down on hours of waiting on hold. Embracing technology enables practices to reduce workload by 94% and reduce overall costs by 50% or even more.

3. Check requirements before hand

It is clear that any delay in prior authorization requests can significantly impact patient care and treatment outcomes. In the case of frequently performed procedures or prescribed drugs physicians will know from their experience whether prior authorization is needed or not. However, it is necessary that they keep an eye on their newsletters, bulletins and websites for any updates regarding prior authorization requirements. Another proactive strategy to avoid delays in providing care is taking the time to check for prior authorization requests before prescribing a drug or recommending a treatment, as per AMA’s advice. This prevents medical service claim denials and delays in filling a prescription on account of unmet prior authorization criteria requirements.

4. Have a good follow-up plan

It is crucial that medical practices keep track of prior authorization requests and follow-up closely and persistently if results are not communicated in a timely fashion. So, make it a point to regularly follow-up on the status of the prior authorization request to ensure that it doesn’t slip through the cracks. Rigorous follow-up ensures timely approval of the prior authorization process.

5. Submit well-written appeals in case of denials

If the insurance carrier inappropriately denies a prior authorization request, you can appeal for a denied prior authorization request. Write a concise, yet powerful denial appeal letter. Submit it along with patient information, reason for disputing the denial, a copy of the initial denial letter, any missing data from initial request and all the additional documents supporting the appeal. This greatly helps to expedite claim appeals, increase the success rate and reduce potential delays.

6. Choose to outsource

The prior authorization process is quite time consuming and frustrating for busy physicians as they have to spend their valuable time persuading insurance companies to cover medications and expensive treatments. With more drugs requiring prior approval than ever before and the advent of new insurance plans each having their own set of policies and guidelines, makes it difficult for physicians to stay current with the changing requirements. Hence, outsourcing the prior authorization process provides access to a team of specialists who are continuously trained on polices and guidelines. Most importantly, it alleviates the burden of filling out paperwork and allows physicians to focus their time and attention on patient care activities.

Prior authorization is a cumbersome, lengthy process that most physicians hate to deal with. Outsourcing prior authorization requirements to specialists in the billing industry not only helps to ease the administrative burden but also ensures faster approvals. They have the right experience and knowledge to handle the prior authorization process with speed and accuracy so that physicians can focus on providing better care and ensuring better health outcomes. If you are a physician struggling with the prior authorization process that is time-consuming, tedious and involves endless paperwork, take help from a medical billing company like Scribe4Me. To know more get it touch with them today.