The insurance preauthorization process is tedious and frustrating, but it’s a requirement if you want to get paid for services you provide. One of the main issues with the process is that each payor has its own requirements for getting procedures preauthorized. Further complicating the system is the fact that what one payor requires preauthorization for isn’t necessarily required by another.
This makes it difficult to create a standard process for your staff to follow when getting preauthorization and can lead to things slipping through the cracks and your practice losing money from denied procedures.
One way you can more easily keep track of what payors require preauthorization is to create a preauthorization CPT code tracking sheet:
Building Your CPT Code Tracking Sheet
To get started, open a spreadsheet in your favorite word processing program – Microsoft Excel and Google Sheets are two popular options. You don’t need anything fancy to get started; you’re just looking for something you can use to start entering which payors require insurance preauthorization for which CPT codes.
For simplicity’s sake, start listing your most common payors across the top of your spreadsheet, and add CPT codes you know require insurance preauthorization down the left column. To make your spreadsheet easier to read, consider changing colors on every other column or row so you don’t accidentally get confused at which cell you’re entering information into.
Work with what you already know or have easily accessible in your notes and files to begin your sheet. You’ll build it out and add more information as you go along, so even simply putting, “Yes,” “No,” or “Unknown” in each column gives you a starting point.
Maintaining Your Tracking Sheet
As you go through the insurance preauthorization process, cross-check your notes and your spreadsheet whenever you talk with a payor regarding a specific CPT code. Adding dates to each cell may be helpful so you know whether the information in your sheet may be outdated.
Whenever you receive new communication from a payor regarding particular CPT codes, be sure to update your spreadsheet accordingly.
Having a section for notes, or linking documents to your spreadsheet, is a great way to keep as much information as possible in one place so that anyone who may have to handle preauthorizations has the access they need. Also, be sure to keep the spreadsheet on your practice’s intranet or other file sharing program so a current copy can be opened by anyone on your team.
A Note of Caution
While creating a CPT code tracking spreadsheet is great to quickly reference which payors require preauthorization for what services, don’t rely solely on the information in your spreadsheet.
It’s always well worth a few minutes spent on the phone to double-check whether insurance preauthorization is required by a payor than to risk having a patient’s procedure denied once it’s already been completed. Your tracking sheet should always be your starting point but do your due diligence and verify the information you’ve collected frequently.
Prior authorizations are a complicated mess that just make your daily life frustrating. But with the right process and know-how, you can make things go a little more smoothly for you and your team – and get paid everything you’re owed. For proven insurance preauthorization tips and tricks, check out Healthcare Training Leader’s online training session, Cut Through Preauthorization Red Tape and Boost Your Pay up. Sign up for this valuable training today.
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