Most patients are waiting for prior authorizations and that wait is negatively impacting their care. That’s why it’s critical that you get patient prior authorizations approved as quickly as possible — so you can get paid and your patients can get the treatment they need.

The good news is that you can reduce your prior authorization burden when you organize your workflow with a focus on forming relationships, improving accuracy, and remaining diligent. Here are 8 tips to help you get those prior authorizations approved faster.

1. Push Prior Authorization to Avoid Treatment Abandonment

Requesting prior authorization for a patient service is more than a formality — it’s a process that deeply affects patient health. A 2017 AMA Prior Authorization Physician Survey reported that, in a one-week time span, 64% of physicians waited at least one business day for a prior authorization decision from a patient’s health plan, and 30% reported they waited at least three business days. Furthermore, 92% of physicians reported that the process does indeed delay access to medical care, 78% reported that these delays often lead to treatment abandonment, and 92% report that the process can have a negative impact on patient outcomes.

2. Maximize Your Practice Management (PMS) and Electronic Medical Records (EMR) Systems

You are likely paying a lot of money for your PMS/EMR systems, so maximize their efficiency! Work with your PMS/EMR vendors to develop the management reports that you need to monitor and perfect your prior authorization process efficiency. Use it to create workflows that don’t allow for a margin of error. Your management reports should demonstrate when authorizations are required and when they are obtained. Also, take advantage of other resources supplied by your PMS/EMR vendor, such as user groups and conferences.

User groups are a great way to connect with other users and administrators who might have different solutions that you haven’t tried. Attending conferences offers a great opportunity to let your vendors know your needs. For example, if they aren’t offering the reports you need to get your prior authorizations covered, let them know because you’re probably not the only one.

3. Educate Physicians on Documentation Requirements to Support Approval

It’s important that providers are educated in the patient prior authorization process. They should know what insurance the patient has and who to contact if the procedure changes midstream. But they should also be educated on the entire process because their documentation is so important to the process.

Make sure they understand conservative treatment because insurance companies will generally want to know that conservative treatment failed before approving a more invasive procedure. Let the physicians know about your challenges and give them feedback. If they don’t want to listen, collect and deliver the lost revenue numbers to them. Most often numbers speak louder than words!

4. Improve Intake Accuracy With Required Exact Info

Patient intake is often the main cause of missed prior authorization, so it’s vital that all the information you collect for prior authorization is accurate. Make sure you use exact spelling for patient name and address on the prior authorization, the same way you have it in your systems already.

Most PMS and EMR systems copy over subscriber information from the patient Educate your intake team so they know the ins and outs and intricacies of the payers.

If the subscriber is someone other than the patient, not having that subscriber information will slow down the process.  Make sure you have the correct claims address for the payer, because many payers cross over state lines and have multiple addresses. If the prior authorization team doesn’t know exactly where to go to get that prior authorization, they are wasting their time.

5. Work Your Denials and Flag Prior Authorizations Combos

Denials are a burden, but you can turn them into a learning opportunity. Working through your denials can help you avoid them in the future. Your practice management system should offer denial reports to find out why the denial occurred in the first place.

Use these reports to find out what happened and look for patterns. Then, work with your PMS/EMR vendor to create a system that will have your software work for you. For example, create reports that flag combinations of payers and procedures that require prior authorization so your team has a heads up.

6. Know Payer Policy and Track It

Policies are specific to each payer, and most payers post coverage related policies online. You should know and keep track of these policies, track changes, and keep copies of archived policies. If a payer is going to dispute you over a 2018 denial it should be with a 2018 policy, but sometimes even they aren’t on top of what policy is in dispute.

That’s why it’s so important for you to be on top of your game. It’s also good practice to keep copies of published newsletters, emails, and anything else that payers send that is related to their current policy.

7. Form Beneficial Relationships with Your Provider Reps

The provider representative is the liaison between the insurance company and your medical practice, and they’re there to explain coverage, verify benefits, and maintain a good relationship between you and their respective insurance company. That means it’s their job to keep you in their network — use that to your advantage. Get to know your rep. Talk to them about your challenges, as they relate to the prior authorization process.

Invite them to visit your practice, sit with your physician, and tour your facility. This relationship will go a long way to ease patient challenges. While payers view the prior authorization process as an effective means to determine medical necessity and select the most economical treatment plan for the patient, you may still be frustrated by how time consuming it can be to obtain these approvals and navigate the system.

8. Train on More Ways to Speed Up Prior Authorization

During the upcoming online training from preauthorization expert and consultant, Gina Piccirilli, CPC, CPMA, on Wednesday, January 15th at 1pm ET, Gina will provide you with an A-Z attack on your preauthorization process that will help you improve your overall reimbursement. Here are just a few of the proven prior authorization strategies you’ll receive from this 60-minute online training:

• Improve medication & testing authorizations and stop wasting time on the phone
• Overturn more rejected authorizations with proven 3-step-process
• Stop preauthorizations and their payments from slipping through the cracks
• Cut denials for medical necessity, and improve claim payup percentage
• And much more!

Prior Authorization Approvals  Online Training and Resources